Associate, Payment Integrity

2 hours, 46 minutes ago
Full-time
Junior
Data Science and Analytics
Oscar

Oscar

Oscar is a health insurance company that offers plans for individuals, families, and small businesses. With a focus on humanizing health care through technology, design, and data, Oscar provides easy-to-understand bills, 24/7 access to doctors, and a p...

Insurance
1K-5K
Founded 2012

Description

  • Provide subject matter expertise in payment integrity claims processing edits, vendor edits, and reimbursement policies.
  • Identify claims payment issues through data mining and process monitoring, then define remediation steps.
  • Respond to internal and external inquiries and disputes related to policies and edits.
  • Document industry-standard coding rules and recommend updates to reimbursement policy language and scope.
  • Translate payment integrity opportunities into business requirements and collaborate with internal partners to implement changes.
  • Train and educate team members when needed.
  • Keep stakeholders informed on progress, status changes, blockers, and completion.
  • Support run-state objectives through research, root cause analysis, and issue escalation support.
  • Ensure compliance with all applicable laws and regulations.
  • Perform other duties as assigned.

Requirements

  • Bachelor's degree or 4+ years of commensurate experience.
  • 4+ years of experience in claims processing, coding, auditing, or health care operations.
  • 4+ years of experience in medical coding.
  • Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA).
  • Experience with reimbursement methodologies, provider contract concepts, and common claims processing/resolution practices.
  • 3+ years of ability to work independently and drive projects to completion.
  • 3+ years of experience in a technical role or process improvement role such as QA analyst, PM, operations analyst, finance, consulting, industrial engineering, Six Sigma, or similar (preferred).
  • 3+ years of experience working with large data sets using Excel or a database language (preferred).
  • Experience in a professional healthcare claims organization (preferred).
  • Knowledge management, training, or content development experience in operational settings (preferred).
  • Process Improvement or Lean Six Sigma training (preferred).
  • Experience using SQL (preferred).

Benefits

  • Base salary of $82,717 to $108,566 per year.
  • Eligibility for annual performance bonuses.
  • Remote work for candidates located in eligible metro areas.
  • Unlimited vacation program.
  • Medical, dental, and vision benefits.
  • 11 paid holidays, paid sick time, and paid parental leave.
  • 401(k) plan participation, life and disability insurance.
  • Paid wellness time and reimbursements.

Interested in this position?

Apply directly on the company website

Apply Now

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