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Payment Integrity Associate - Itemized Bill Review

1 hour, 28 minutes ago
United States
Full-time
Junior
Operations Specialist
Operations
SQL
Apply Now
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
View All Jobs 77

Description

  • Perform line-by-line review of high-dollar facility itemized bills and corresponding claim forms such as UB-04s.
  • Identify and document billing errors, including duplicate charges, improper unbundling, and charges for non-covered or non-rendered services.
  • Compare billed charges against payor-specific contracts and industry guidelines to verify appropriate billing practices.
  • Apply knowledge of national coding systems such as CPT, HCPCS, ICD-10, and MS-DRGs to validate billed service codes.
  • Review claims under percentage-of-charges or stop-loss reimbursement scenarios and confirm minimum dollar thresholds are met.
  • Prepare clear documentation of findings, savings identified, policy violations, and recommended claim adjustments.
  • Contribute to the refinement of internal audit processes and tools to improve accuracy and efficiency.
  • Serve as a subject matter expert for billing issues, coding guidelines, payor policies, and reimbursement policies.
  • Identify claims payment issues through data mining and process monitoring, and define remediation steps.
  • Respond to internal and external inquiries and disputes related to policies, edits, and claim issues.
  • Document coding rules and recommend reimbursement policy language and scope improvements.
  • Translate payment integrity opportunities into business requirements and collaborate with internal partners to implement changes.
  • Provide training, education, root cause analysis, and research support when issues are escalated.
  • Maintain transparent communication with stakeholders regarding progress, blockers, and status changes.

Requirements

  • Bachelor's degree or 4+ years of commensurate experience.
  • 2+ years of bill/coding audit experience focused on hospital or facility billing (UB-04).
  • 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 experience working with large data sets using Excel or a database language (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

  • Remote work with a flexible work arrangement, open to candidates in select U.S. metro areas.
  • Base salary of $82,717 to $108,566 per year.
  • Eligibility for annual performance bonuses.
  • 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, and paid wellness time and reimbursements.

Interested in this position?

Apply directly on the company website

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