Senior Manager, Revenue Cycle Management, Provider Operations

Hi, we're Oscar. We're hiring a Senior Manager, Revenue Cycle Management to join our Provider Operations team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Senior Revenue Cycle Manager, Provider Operations is responsible for leading and optimizing revenue cycle operations across Oscar Medical Group. The role owns the development and execution of scalable revenue cycle strategies and processes that support accurate coding, compliant billing, timely reimbursement, and overall financial performance. This leader will serve as a subject matter expert in professional billing and coding and will partner closely with clinical, operations, finance, compliance, credentialing, product, to identify revenue cycle risks and opportunities and translate them into actionable operational strategies.

The Senior Manager will establish performance standards, controls, reporting, and workflows across the revenue cycle while using data and root-cause analysis to drive measurable improvements in revenue capture, claims performance, coding accuracy, and provider documentation. This role will also provide strategic guidance to OMG leadership on revenue cycle performance, risks, and opportunities as the organization grows and evolves.

You will report into the Director, Clinical Operations.

Work Location:

This is a remote position, open to candidates who reside in:
Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote Pay Transparency:
The base pay for this role is: $122,212 - $160,404 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

Own the strategy and performance of OMG's revenue cycle function, including professional billing, coding, claims management, denials, eligibility, documentation, and related workflows.

Serve as the senior subject matter expert for coding and billing, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, and payer requirements.

Establish and monitor revenue cycle KPIs and controls, using data and root-cause analysis to improve clean claims, coding accuracy, reimbursement, denial rates, and overall financial performance.

Lead coding and documentation integrity strategies, including pre- and post-bill review, provider queries, addendums, signatures/co-signatures, identification of inappropriate documentation practices or cloning, and proactive provider education to address documentation gaps and support accurate coding.

Lead denial prevention and resolution strategies, identifying systemic trends and partnering across teams to implement sustainable corrective actions.

Partner with clinical leadership on ICD-10/HCC documentation and coding, identifying opportunities to improve accurate capture of clinically supported diagnoses.

Evaluate payer-specific performance, requirements, and coding considerations, developing strategies to address reimbursement, eligibility, claim edits, denials, and other revenue cycle issues while incorporating payer expertise into coding and operational processes.

Partner cross-functionally with Clinical Operations, Finance, Compliance, Credentialing, Product/Technology, and other stakeholders to resolve complex revenue cycle issues and support new programs and services.

Develop scalable revenue cycle policies, workflows, governance, and vendor oversight to support a growing, multi-state provider organization.

Advise OMG leadership on revenue cycle performance, financial opportunities, operational risks, and recommended strategies, leading complex initiatives from identification through implementation and measurement.

Compliance with all applicable laws and regulations Other duties as assigned Requirements:7+ years of progressive experience in healthcare revenue cycle, professional billing, coding, or related healthcare operations.
3+ years of experience leading revenue cycle programs, teams, or functions with accountability for operational and/or financial outcomes.

Advanced knowledge of professional billing and coding, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, claims…