Remote Itemized Bill Auditor

Oscar Health Insurance; United States; Remote; USD 83,000 - 109,000; Full time

Benefits offered by this job

Medical, dental, vision

Unlimited vacation

Paid holidays

Job summary

Oscar is seeking an Associate, Itemized Bill Reviewer (IBR) to execute payment integrity solutions using billing and coding expertise. You will ensure accurate, timely claim payments and collaborate cross-functionally to translate stakeholder friction into improvement opportunities.

This role reports to the Manager, Payment Integrity (Pre-Pay). The position is fully remote for US residents (except certain states), with travel for team meetings and events.

Qualifications

• 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

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
• Compare billed charges against both payor-specific contracts and industry guidelines to confirm appropriate billing practices
• Apply working knowledge of national coding systems (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
• 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
• 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
• Provide training and education to team members when necessary
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Skills

Billing audits

Medical coding

Certification (CPC/COC or CCS/RHIT/RHA

Education

Bachelor's degree or 4+ years experience

Tools

UB-04 knowledge

Job description

Oscar is seeking an Associate, Itemized Bill Reviewer (IBR) to execute payment integrity solutions using billing and coding expertise. You will ensure accurate, timely claim payments and collaborate cross-functionally to translate stakeholder friction into improvement opportunities.

This role reports to the Manager, Payment Integrity (Pre-Pay). The position is fully remote for US residents (except certain states), with travel for team meetings and events.