Senior Analyst, Payment Integrity

15 hours, 23 minutes ago
Full-time
Senior
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

  • Serve as a subject matter expert on reimbursement policies, payment integrity claim edits, and external vendor edits.
  • Respond to internal and external inquiries and disputes related to policies and claims 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 actionable changes.
  • Collaborate with internal partners to scope, size, prioritize, and deliver solutions for adverse claim outcomes.
  • Use data mining, partner feedback, and process monitoring to proactively identify trends and problem areas.
  • Communicate progress, status changes, blockers, and completion updates to stakeholders.
  • Provide rapid research, root cause analysis, and training support for escalated issues assigned by leadership.
  • Ensure compliance with all applicable laws and regulations.

Requirements

  • Bachelor’s degree or 4+ years of commensurate experience.
  • 3+ years of experience in claims processing, coding, auditing, or health care claims operations.
  • 3+ years of experience in medical coding within payment integrity.
  • 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/or external stakeholders.
  • Bonus points: 2+ years in a technical role or process improvement role such as QA analyst, PM, operations analyst, finance, consulting, industrial engineering, Six Sigma, or similar.
  • Bonus points: Process Improvement or Lean Six Sigma training.
  • Bonus points: Experience using SQL.

Benefits

  • Base salary of $64,832 to $85,092 per year.
  • Eligibility for employee benefits.
  • Unlimited vacation program.
  • Annual performance bonuses.
  • Medical, dental, and vision insurance.
  • 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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