Itemized Bill Review Specialist, Payment Integrity

Oscar Health; Tempe (AZ); Híbrido; USD 83 000 - 109 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, dental, and vision benefits

Unlimited vacation

Annual performance bonuses

Resumo da oferta

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.

Qualificações

• 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.

Conhecimentos

Billing & coding audit

Medical coding

SQL

Excel

Formação académica

AAPC CPC/COC or AHIMA CCS/RHIT/RHIA

Ferramentas

SQL

Excel

Descrição da oferta de emprego

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.