Itemized Bill Review Associate — Payment Integrity (Hybrid)

name; Tempe (AZ); Hybrid; USD 83,000 - 109,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid holidays

Paid sick time

Parental leave

Life and disability insurance

Wellness time and reimbursements

Job summary

Oscar Health in Tempe, AZ is hiring an Associate, Payment Integrity, Itemized Bill Review (IBR). The role executes billing/auditing with coding expertise to ensure accurate and timely payments, interfacing across teams to translate issues into improvements.

The position reports to the Manager, Payment Integrity (Pre-Pay) and requires a hybrid schedule with three in-office days weekly. Base pay ranges from $82,717 to $108,566 per year, with benefits and performance bonuses.

Qualifications

• 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 via AAPC (CPC/COC) or AHIMA (CCS/RHIT/RHIA).
• Experience with reimbursement methodologies and provider contracts.

Responsibilities

• Perform line-by-line review of high-dollar facility itemized bills and related claim forms.
• Identify and document potential billing errors including duplicate billing and improper unbundling.
• Compare billed charges against payor contracts and guidelines to confirm proper billing.
• Apply CPT/HCPCS/ICD-10/MS-DRGs knowledge to validate codes.
• Review claims under specific reimbursement scenarios and thresholds.
• Document findings and recommended claim adjustments clearly and professionally.
• Refine internal audit processes and tools to improve accuracy and efficiency.
• Serve as SME for internal/external stakeholders on billing issues and policies.
• Provide training and education to team members as needed.
• Support state objectives and respond to inquiries and disputes.

Skills

Medical coding

Billing/auditing

UB-04 knowledge

SQL

Excel

Data analysis

Education

Bachelor's degree or 4+ years experience

AAPC/AHIMA certification

Tools

SQL

Job description

Oscar Health in Tempe, AZ is hiring an Associate, Payment Integrity, Itemized Bill Review (IBR). The role executes billing/auditing with coding expertise to ensure accurate and timely payments, interfacing across teams to translate issues into improvements.

The position reports to the Manager, Payment Integrity (Pre-Pay) and requires a hybrid schedule with three in-office days weekly. Base pay ranges from $82,717 to $108,566 per year, with benefits and performance bonuses.