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Senior Analyst, Payment Integrity Disputes

1 hour, 51 minutes ago
United States
Full-time
Senior
Business Analyst
Data Science and Analytics
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 88

Description

  • Contribute as a subject matter expert on reimbursement policies, payment integrity disputes, claims processing edits, and external vendor edits.
  • Respond to internal and external inquiries and disputes related to policies and edits.
  • Research industry-standard coding rules and help shape reimbursement policy language and scope.
  • Identify payment integrity opportunities from claims research and translate them into business requirements and process changes.
  • Collaborate with internal partners to scope, size, prioritize, and implement solutions for adverse claim outcomes.
  • Analyze partner submissions, data mining, and process monitoring outputs to proactively identify recurring problem areas.
  • Communicate progress, status changes, blockers, and completion updates to stakeholders.
  • Support leadership escalations by providing rapid research, root cause analysis, and training as needed.
  • Ensure compliance with all applicable laws and regulations.

Requirements

  • Experience in payment integrity focused on disputes and/or appeals.
  • 4+ years of experience in claims processing, coding, auditing, or health care operations.
  • 3+ 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.
  • 2+ years of experience deriving business insights from datasets and solving problems.
  • 1+ years of experience improving business workflows and processes.
  • 1+ years of experience collaborating with internal and external stakeholders.
  • 2+ years of experience in a technical role or process improvement role such as Six Sigma (preferred).
  • 2+ 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 $64,832 - $85,092 per year.
  • Eligibility for employee benefits.
  • Participation in Oscar's unlimited vacation program.
  • Annual performance bonuses.
  • Medical, dental, and vision insurance.
  • 11 paid holidays and paid sick time.
  • 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

Apply Now

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