Credentialing and Audit Associate at Oscar

What is the position?

At Oscar, we are working hard to provide the kind of health insurance we would want for ourselves. This means that we get to be creative and to build an excellent insurance operation from the ground up.

The Credentialing and Audit Associate is responsible for overseeing credentialing of our provider network, leading regulatory efforts for the Network Operations, and ensuring that we build sound processes. We are looking for a highly qualified person who can excel and innovate in this role. The role will combine responsibilities for managing credentialing responsibilities with our core network partners as well as day-to-day operations and process improvement around credentialing. The position will report to the Manager of Network Operations.

Deliverables: What you have to achieve

During your first six weeks,

  • You’ll get acquainted with the credentialing responsibilities. In particular, you’ll
    • Quickly develop an informed view of Oscar’s credentialing system, processes and delegated relationships
    • Manage the relationship with Oscar’s NCQA certified credentialing vendor
    • Establish rapport with Oscar’s delegated network partners
    • Conduct extensive research to refine existing Credentialing Policies & Procedures
  • You’ll develop an outlook on our audit needs. To do this, you’ll
    • Become familiar with internal policies, state and federal regulations, and industry best practices that relate to Network Operations
    • Work with compliance, regulatory and legal teams to identify and prioritize process gaps and areas for improvement
    • Develop a 12-month calendar of the team’s regulatory responsibilities

During the first four months,

  • You’ll assume credentialing responsibilities
    • Oversee the approvals of our directly credentialed providers and hold our credentialing vendor accountable to meeting service level agreements
    • Work with Network Account Managers to assure our network partners are credentialed and that our delegated credentialing partners are audited
    • Coordinate and lead quarterly Credentialing Committee meetings
  • You’ll assume audit, compliance, and regulatory responsibilities
    • Draft and compile regulatory submissions on behalf of Network Operations
    • Coordinate with regulatory and legal teams to respond to external audits
    • Attend and participate in regulatory working groups
    • Work with teams across Oscar to improve external policies and communicate these policies to our network via our provider manual
  • You’ll serve as a change agent
    • Improve credentialing and audits tools and processes so that they are scalable, robust and result in a positive experience amongst all providers
    • Recommend and implement improvements to processes across Network Operations with respect to internal policies, state and federal regulations, and industry best practices
    • Serve as subject matter expert on credentialing to inform improvements in contracting and data management processes.
    • Ensure that providers and members have great experiences by developing and improving internal policies

Afterwards and on an ongoing basis,

  • Continue to build and improve our credentialing function
  • Ensure credentialing attribution for Oscar's networks and regulatory compliance
  • Ensure network excellence by designing processes adhere to best practices and regulations
  • Serve as Oscar’s subject matter expert on all things credentialing

Winning factors: What leads to success

In this role, you have to manage and scale the credentialing function for Oscar's network in our fast-moving environment. Must-have qualifications and expertise include:

  • A bachelor’s degree or equivalent
  • Ability to work with and coordinate large groups of people across multiple work streams
    • Excellent communication skills with experience interacting with a broad array of teams
    • Strong coordination and project management skills, with experience overseeing large projects
    • Organized and detail-oriented
  • Ability to synthesize information to quickly and effectively problem solve as well as implement solutions, including:
    • Strong problem solving skills
    • High degree of comfort with Excel, Word, Google Docs, and Google Sheets
  • A can-win attitude and flexibility
    • Passion for building something new in a dynamic startup environment
    • Love finding quick, smart solutions to complex problems
    • Adaptable to quickly changing requirements and anticipate changing priorities

We think it will make a big (positive) difference if you have experience in any of the following:

  • Credentialing
  • Working with or in audit, compliance, legal or regulatory teams
  • Interacting with providers and hospital systems
  • Working in an insurance or a professional services environment

Bonus points for:

  • NAMSS (National Association Medical Staff Services) Certification
  • Familiarity with credentialing standards and regulations, including NCQA, CA - Department of Managed Health Care (DMHC), NY - Department of Financial Services (DFS), and/or Texas Department of Insurance (TDI)

Oscar is an equal opportunity employer. Should you be a fit for this role, one of our recruiters will contact you from a hioscar.com e-mail address. Oscar recruiters do not request your sensitive personal information by email.

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