Itemized Bill Reviewer

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

Benefits offered by this job

Benefits and flexibility

Hybrid schedule (3 days in-office)

Performance bonuses

Job summary

Oscar Health in Tempe, AZ is seeking an Associate, Payment Integrity, Itemized Bill Review to execute billing and coding audits and drive improvement in claim accuracy.

You will review high-dollar itemized bills, leverage CPT/HCPCS/ICD-10 knowledge, and work cross-functionally to translate issues into actionable fixes. This role reports to the Manager, Payment Integrity (Pre-Pay).

Qualifications

• Bachelor's degree or 4+ years commensurate experience.
• 2+ years bill/coding audit experience with hospital/facility focus.
• 4+ years medical coding experience.
• AAPC CPC/COC or AHIMA CCS/RHIT/RHIA certification preferred.

Responsibilities

• Perform line-by-line review of high-dollar facility itemized bills and related claim forms.
• Identify and document potential billing errors, including duplicate or improper unbundling and non-covered services.
• Compare billed charges against payor contracts and industry guidelines to verify proper billing.
• Apply knowledge of CPT, HCPCS, ICD-10, MS-DRGs to validate codes.
• Review claims under specific reimbursement scenarios to ensure thresholds are met and appropriate decisions are made.
• Prepare clear documentation of findings, including savings and recommended adjustments.
• Contribute to refining internal audit processes and tools for efficiency and accuracy.
• Serve as a subject matter expert on billing issues, coding guidelines, and payor policies.

Skills

Billing audit

Medical coding

Data analysis

Excel

Reimbursement concepts

Education

Bachelor's degree or 4+ years commensurate experience

Tools

SQL

Job description

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.

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

Bonus points:

• 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.

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