Itemized Bill Review Associate - Payment Integrity

Oscar Health; New York (NY); Híbrido; USD 92 000 - 121 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health benefits

Unlimited vacation

Annual bonus

Hybrid schedule

Resumo da oferta

Oscar Health in New York City is hiring an Associate, Payment Integrity, Itemized Bill Review (IBR). You will execute line-by-line reviews of high-dollar facility bills and claim forms, applying CPT/HCPCS/ICD-10 knowledge to validate codes and surface actionable improvement opportunities.

This role requires a bachelor’s degree or 4+ years of commensurate experience, 2+ years in hospital bill audits, 4+ years in medical coding, and a current AAPC or AHIMA credential.

Qualificações

• 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.

Responsabilidades

• 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 or improper unbundling.
• Compare billed charges against contracts and guidelines to confirm billing practices.
• Apply knowledge of CPT/HCPCS/ ICD-10 to validate codes used for services billed.
• Prepare clear documentation of findings and recommended claim adjustments.
• Provide SME guidance on billing issues and policy language.

Conhecimentos

Bill / coding audit

Medical coding

Reimbursement methodologies

Data sets

Formação académica

Bachelor's degree or 4+ years of commensurate experience

Ferramentas

SQL

Excel

Descrição da oferta de emprego

Oscar Health in New York City is hiring an Associate, Payment Integrity, Itemized Bill Review (IBR). You will execute line-by-line reviews of high-dollar facility bills and claim forms, applying CPT/HCPCS/ICD-10 knowledge to validate codes and surface actionable improvement opportunities.

This role requires a bachelor’s degree or 4+ years of commensurate experience, 2+ years in hospital bill audits, 4+ years in medical coding, and a current AAPC or AHIMA credential.