Senior Manager, Provider Partner Compliance
Oscar, New York
A better kind of health insurance company
At Oscar, we believe that our success is due in no small part to our member-focused, “high-touch” service model. To support this model, Oscar partners with medical professional corporations in several states, through which doctors provide remote care to our members, and with at the Oscar Clinic, an innovative facility in Brooklyn open to our New York-based members for holistic, in-person care. Together, these provider entities pose a unique set of compliance challenges that Oscar is contracted to address on their behalf. We are looking for a dynamic and experienced individual – based in Oscar’s New York headquarters and reporting to our Vice President of Compliance – to assume primary responsibility for tackling these challenges, to prepare the provider entities for further growth, and in so doing to ensure that our members continue to receive the high-quality care they deserve.
In your first six weeks, you will:
- Familiarize yourself with the structures of Oscar’s corporate family and of its provider partners, and their interactions in various states
- Meet the people who staff and support the provider entities, to get a sense of the work they do and the challenges they face in their interactions with Oscar
- Begin to identify risks that the provider entities’ Compliance Program should address
By the end of month 3, you will:
- Assume primary responsibility for further developing the provider entities’ Compliance Programs (including HIPAA and state-specific privacy requirements)
- Familiarize yourself – to the extent you are not already familiar – with state-specific laws and regulations telemedicine and telehealth
- Review the provider entities’ billing practices with respect to to government payors, and identify areas for improvement
- Map current compliance monitoring practices among the provider entities, and begin to identify areas for improvement
Afterwards and on an ongoing basis, you will:
- Complete an annual risk assessment of the provider entities, so as to develop, maintain, and execute on an annual Compliance Work Plan for each
- Provide guidance on clinical quality programming and oversight required for the provider entities
- Monitor key compliance and quality metrics in all markets, and oversee corrective action as required
- Maintain and continually improve the provider entities’ privacy programs, including identifying and remediating gaps, and developing and delivering trainings as necessary
- In coordination with Oscar’s Legal Department, respond to the provider entities’ compliance-related questions as they arise
- In coordination with Oscar’s People Team, ensure that issues respecting provider employment and contracting are identified and addressed
- Support the provider entities’ entry into new states and markets
- Ensure that the provider entities understand and adhere to laws and regulations respecting licensure in all states
- Conduct compliance- and quality-focused audits of the provider entities’ activities, and oversee corrective action as required
Winning factors: What leads to success
We are looking for someone with a deep knowledge of provider-side compliance who is excited to help promote a culture of compliance and ethics at Oscar and at the provider entities.
Must-have qualifications and expertise include:
- College degree
- 4+ years’ experience in a provider-side compliance, practice management, or quality setting
- Experience with HIPAA, data privacy, or data security processes
Preferred qualifications include:
- CHC, CPPM, CPCO, CCP, CCEP, or similar
- Managerial experience
- Experience with billing government payors, including Medicare Advantage, and coordination of benefits
We think you will be successful if...
- You have experience directly interacting with regulators
- You understand the unique challenges and exciting opportunities posed by telemedicine and telehealth
- You are a critical thinker who can distill complex concepts and regulatory requirements into easy to understand action items
- You have acute attention to detail and always strive for perfection when writing formal documents
- You get things done, even if it’s crunch time
- You enjoy working in a collaborative environment and working cross-functionally with all business areas within the organization
- You are personable, self-starting and organized
- You have passion for healthcare and a knack for making processes more systematic
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we work to cultivate an environment where exceptional people can be their most authentic selves and find both belonging and support. We're on a mission to change healthcare -- an experience made whole by your unique background and perspectives.
Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email protected]) to make the need for an accommodation known.
Pay Transparency Policy: Oscar's Pay Transparency Policy ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.
Founded in 2012, Oscar is probably the last thing you would expect from a technology startup – a seemingly old-fashioned healthcare insurance provider. The company provides clients with the kind of clarity and simplicity we have come to expect from an e-commerce site. And, of course, they're hiring.
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