What is the Position?
At Oscar, we work 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.
We are looking for a coordinator to support our quality of care investigations and follow up for Medicare Advantage and commercial products. We deal with our members' most sensitive issues and are looking for someone who can contribute positively to the level of work we do. In this role you will own quality of care coordination. To do this, you will work closely with clinical staff to build PQI case investigation, communicate with providers and facilities (via phone or email), coordinate with other Oscar teams, and ensure compliance and confidentiality. Additionally, you will support the Quality Improvement Program and MA activities in regulatory and accreditation audits through the preparation of documentation.
This is a clinical support role, and no clinical experience is necessary (though it will help)!
Deliverables: What you have to achieve
During your first six weeks: You have...
- Developed a comprehensive understanding of Oscar's Potential Quality Issue processes and overall workflow.
- Learned to use our internal tools to manage your work and resolve or escalate issues as needed.
- Become comfortable interacting with providers via phone and in writing.
- Begun to form strong working relationships with internal and external stakeholders.
- Begun to work closely with other QI staff to understand audit submission needs.
- Researched Medicare Advantage (MA) regulatory requirements for the Quality of Care program.
Afterwards and on an ongoing basis: You continue to...
- Continue to improve the documentation and efficiency of PQI investigation and medical record audits.
- Build out operational workflows for the Quality of Care program to be compliant with MA requirements.
- Assist and/or lead special projects to improve team processes that ensures efficient growth as Oscar expands to new products and geographies.
- Conduct provider outreach on sensitive issues to investigate, advocate and build/maintain positive relationships with our network of healthcare providers
- Work with other QI staff to provide insight and ideas on system improvements.
- Support regulatory audits as needed.
To be successful, you will need the following skills / traits:
- Service orientation: we interact with providers daily, and represent the Oscar brand - a better healthcare experience
- Detail oriented: we deal with members' care and personal health information, accurate information is critical
- Comfortable with new technology: we are a tech-driven insurer and you will need to be comfortable working on a Mac and navigating across multiple programs to effectively drive your work
- Strong verbal communication, including phone demeanor: you will need to be comfortable on the phone, asking for information, communicating decisions with provider offices, hospital staff, and vendors
- Curiosity: we deal with several different processes and often you'll have questions; it's imperative that you be comfortable asking a colleague or supervisor
- Problem solving: handling patient care cases can sometimes be complex. We need people that love to solve puzzles and exercise critical thinking in order to complete the task at hand
- Collaboration: our most successful hires are driven to grow, learn and work as a member of a cross-functional team with both clinical and non-clinical team members
- Passion for healthcare: every case we deal with has a patient behind it. We need people that care about quality to help drive the best healthcare experience for our members
- Strong multitasking skills: you will need to be able to multitask, we work with time sensitive cases, providers and other internal stakeholders.
We think it will make a big (positive) difference if you have...
- A bachelor’s degree (healthcare related degree license or certification) or additional relevant years of work experience.
- Knowledge of healthcare and medical terminology.
- Experience handling Personal Health Information (PHI) in a professional manner.
- Experience entering accurate data in a production-driven environment.
- Ability to balance competing priorities and continue to execute projects with excellence.
- 1-3 years of quality improvement/management/coordination, Medicare Advantage, insurance, or healthcare delivery experience.
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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Want to learn more about Oscar? Visit Oscar's website.
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