Senior Analyst, Payment Integrity

Jobtailor; Deutschland; Remote; EUR 60.000 - 85.000; Vollzeit

Zusammenfassung

Jobtailor in Germany seeks a specialist to drive process improvements in the Oscar claim environment, resolving issues and enhancing workflows.

You will apply expertise in medical coding, reimbursement policies, and data analysis to deliver solutions, partner with stakeholders, and ensure compliance.

Qualifikationen

• Bachelor’s degree or 4+ years experience in relevant fields.

Aufgaben

• Support process improvement and issue resolution in Oscar claim environment.
• Organize, scope, prepare, investigate and execute solutions and process improvements.
• Leverage Oscar’s claim infrastructure, workflows, platform logic and data models.
• Contribute as a subject matter expert for reimbursement policies and edits.
• Respond to inquiries and disputes regarding policies and edits.
• Research industry coding rules and input into reimbursement policy language.
• Identify payment integrity opportunities and translate them into business requirements.
• Collaborate with internal and external partners to scope, prioritize and deliver solutions.
• Analyze partner submissions, data mining and process monitoring to identify opportunities.
• Keep stakeholders informed of progress, blockers and completion.
• Provide research, root cause analysis and training for escalated issues.
• Comply with applicable laws and regulations.

Kenntnisse

Claims Processing

Medical Coding

Auditing

Data Analysis

Process Improvement

Reimbursement Methodologies

Business Insights

Root Cause Analysis

Issue Resolution

Stakeholder Collaboration

Ausbildung

Bachelor's degree or equivalent

CPC

COC

CCS

RHIT

RHIA

Tools

Workflow Tooling

Data Models

Claim Infrastructure

Jobbeschreibung

• Support process improvement and issue resolution in the Oscar claim environment for Oscar Insurance and +Oscar clients
• Organize, scope, prepare, investigate and/or execute solutions and process improvements within edits and ideation
• Leverage Oscar’s claim infrastructure, workflows, workflow tooling, platform logic and data models
• Contribute as a subject matter expert for reimbursement policies and internal and external claims processing edits
• Respond to internal and external inquiries and disputes regarding policies and edits
• Research industry standard coding rules and provide input into reimbursement policy language and scope
• Identify payment integrity opportunities and translate them into business requirements
• Collaborate with internal and external partners to scope, prioritize and deliver solutions
• Analyze partner submissions, data mining and process monitoring to identify opportunities
• Keep stakeholders informed of progress, status changes, blockers and completion
• Provide research, root cause analysis and training for escalated issues
• Comply with applicable laws and regulations

Requirements

• A bachelor’s degree or 4+ years of commensurate experience
• 4+ years of experience in claims processing, coding, auditing or health care operations
• 3+ years 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 experience deriving business insights from datasets and solving problems
• 1+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and/or external stakeholders

Core Competencies

Demonstrates expertise in medical coding and claims processing, with a strong focus on payment integrity and reimbursement methodologies. Proven ability to analyze data, improve workflows, and collaborate effectively with stakeholders to deliver solutions.

Highest-signal resume keywords

• Medical Coding Certification
• Claims Processing Experience
• Payment Integrity Expertise
• Data Analysis Skills
• Workflow Improvement Experience

ATS Optimization Keywords

Hard Skills

• Claims Processing
• Medical Coding
• Auditing
• Data Analysis
• Process Improvement
• Reimbursement Methodologies
• Business Insights Derivation
• Root Cause Analysis
• Issue Resolution
• Stakeholder Collaboration

Soft Skills

• Communication
• Problem-Solving
• Organizational Skills
• Training Ability
• Collaboration

Certifications & Qualifications

• CPC
• COC
• CCS
• RHIT
• RHIA

Industry Keywords

• Health Care Operations
• Reimbursement Policies
• Coding Rules
• Payment Integrity
• Claims Processing Edits

Tools & Technologies

• Workflow Tooling
• Data Models
• Claim Infrastructure