Itemized Bill Review Associate

Oscar Health; Tempe (AZ); Híbrido; USD 83.000 - 109.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision benefits

Unlimited vacation

Annual performance bonuses

Descripción de la vacante

Oscar Health in Tempe, AZ is seeking an Associate, Payment Integrity, Itemized Bill Review to execute billing and coding audits and improve internal processes. The role requires hospital billing expertise, CPT/HCPCS/ICD-10 knowledge, and cross-functional collaboration to ensure accurate, timely claim payments.

The position reports to the Manager, Payment Integrity (Pre-Pay) and supports QA, policy recommendations, and data-driven improvements within a hybrid work model with in-office Thursdays.

Formación

• Bachelor's degree or 4+ years of commensurate experience.
• 2+ years of bill/coding audit experience with a focus on hospital/facility billing (UB-04).
• 4+ years experience in medical coding.
• Certification through AAPC or AHIMA (as listed).
• 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.
• Knowledge management, training, or content development in operational settings.
• Lean Six Sigma training or exposure.
• Experience using SQL.

Responsabilidades

• Perform line-by-line review of high-dollar facility itemized bills and corresponding claim forms (e.g., UB-04s).
• Identify and document potential billing errors including duplicate billing and improper unbundling.
• Compare billed charges against payor contracts and guidelines to ensure proper billing.
• Apply knowledge of CPT, HCPCS, ICD-10, MS-DRGs to validate codes.

Conocimientos

Billing & coding audit

Medical coding

SQL

Excel

Educación

AAPC CPC/COC or AHIMA CCS/RHIT/RHIA

Herramientas

SQL

Excel

Descripción del empleo

Hi, we're Oscar. We're hiring an Associate, Itemized Bill Review to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Associate, Payment Integrity, Itemized Bill Review (IBR) will be responsible for executing internal payment integrity solutions requiring billing and coding expertise with and continual improvement and development of the solutions. You will ensure claims are paid accurately and timely with the highest quality. This is accomplished by leveraging a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement.

You will report into the Manager, Payment Integrity (Pre-Pay).

Work Location: This position is based in our Tempe, Arizona office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid

Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Perform line-by-line review of high-dollar facility itemized bills and corresponding claim forms (e.g., UB-04s)
• Proactively identify and document potential billing errors, including duplicate billing of items, services, or procedures as improper unbundling of services (e.g., separating components that should be billed together) and charges for non-covered or non-rendered services
• Compare billed charges against both payor-specific contracts and industry guidelines to confirm appropriate billing practices.
• Apply working knowledge of national coding systems (e.g., CPT, HCPCS, ICD-10, MS-DRGs) to validate the accuracy of codes used for services billed.
• Review claims eligible under specific reimbursement scenarios: a percentage of charges or those exceeding stop-loss levels, ensuring the claim exceeds the minimum dollar threshold set by the payor
• Prepare clear, concise, and professional documentation of all findings, including savings identified, policy violations, and recommended claim adjustments
• Contribute to the refinement of internal audit processes and tools to enhance efficiency and accuracy in identifying claim inaccuracies
• Serve as a subject matter expert for internal and external stakeholders regarding complex billing issues, coding guidelines, and payor policies
• Provide subject matter expertise and in-depth understanding of Payment Integrity internal claims processing edits, external vendor edits and Oscar reimbursement policies
• Identify claims payment issues from data mining, process monitoring, etc., provide scoping and action steps needed to remediate the issue
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Document industry standard coding rules and provide recommendations on reimbursement policy language and scope
• Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules. Translate into business requirements; submit to and collaborate with internal partners to effectuate change
• Provide training and education to team members when necessary
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 4+ years of commensurate experience
• 2+ years of bill / coding audit experience with a focus on hospital or facility billing (UB-04)
• 4+ years 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
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Experience using SQL

This is an authentic Oscar Health job opportunity.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Oscar Health is authorized to do business in many, but not all, states. If you are not located in or willing to relocate to a state where Oscar is registered, you will not be eligible for employment. The approved states for this role are listed in the job posting.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey. Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.

As set forth in Oscar Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

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An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.