Payment Integrity Analyst: Itemized Bill Review

Oscar Health; New York (NY); Hybrid; USD 92,000 - 121,000; Full time

Benefits offered by this job

Benefits package

Unlimited vacation

Annual performance bonus

Job summary

Oscar Health is hiring an Associate, Itemized Bill Review (IBR) to join our Payment Integrity team in New York City. The role requires billing and coding expertise to execute internal payment integrity solutions and drive improvements across processes.

You will audit high-dollar itemized bills, apply coding rules, and document findings. The position is hybrid with 3 in-office days weekly. Base salary ranges from $91,908 to $120,629 with benefits and annual bonuses.

Qualifications

• 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; relevant certifications encouraged (CPC/COC or CCS/RHIT/RHIA).
• Experience with reimbursement methodologies and provider contract concepts.

Responsibilities

• Perform line-by-line review of high-dollar facility itemized bills and related claim forms (e.g., UB-04).
• Document potential billing errors and improper unbundling.
• Compare charges against contracts and guidelines to ensure proper billing.
• Apply CPT/HCPCS/ICD-10 coding knowledge to validate codes used.
• Evaluate claims under specific reimbursement scenarios and thresholds.
• Prepare clear documentation of findings and recommended adjustments.
• Refine internal audit processes and tools for accuracy.
• Serve as SME for billing issues with stakeholders.
• Provide training to team members when needed.
• Maintain transparent communication with stakeholders on progress.

Skills

Billing audit

Medical coding

UB-04 familiarity

Reimbursement knowledge

Stakeholder communication

Education

Bachelor's degree or 4+ years experience

Tools

SQL

Excel

Job description

Oscar Health is hiring an Associate, Itemized Bill Review (IBR) to join our Payment Integrity team in New York City. The role requires billing and coding expertise to execute internal payment integrity solutions and drive improvements across processes.

You will audit high-dollar itemized bills, apply coding rules, and document findings. The position is hybrid with 3 in-office days weekly. Base salary ranges from $91,908 to $120,629 with benefits and annual bonuses.