Remote Itemized Bill Auditor & Coding Specialist

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

Job summary

Oscar Health is hiring an Associate, Itemized Bill Reviewer to join our Payment Integrity team. This fully remote role supports accurate and timely claim payment through deep coding and billing expertise.

You will leverage OSCAR's claim infrastructure and cross-functional workflows to translate stakeholder friction into actionable improvements while reporting to the Manager, Payment Integrity (Pre-Pay).

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.
• 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.
• 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.

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 and charges for non-covered or non-rendered services.
• Compare billed charges against payor-specific contracts and industry guidelines to confirm appropriate billing practices.
• Apply working knowledge of CPT, HCPCS, ICD-10, MS-DRGs to validate code accuracy.
• Review claims eligible under specific reimbursement scenarios: percentage of charges or those exceeding stop-loss levels; ensure the claim exceeds the minimum payor threshold.
• Prepare clear, concise documentation of findings including savings identified and recommended claim adjustments.
• Refine internal audit processes and tools to enhance efficiency and accuracy.
• Serve as SME for internal/external stakeholders regarding complex billing issues, coding guidelines, and payor policies.
• Provide SME understanding of Payment Integrity edits and Oscar reimbursement policies.
• Identify claims payment issues from data mining and process monitoring; provide remediation steps.
• Respond to inquiries and disputes regarding policies and edits.
• Document industry standard coding rules and provide reimbursement policy language recommendations.
• Ideate payment integrity opportunities; translate to business requirements and collaborate to implement.
• Provide training and education to team members when necessary.
• Maintain transparency and collaboration; inform stakeholders of progress and blockers.
• Support Oscar run state objectives with research and root-cause analysis when escalated.
• Comply with all applicable laws and regulations.
• Other duties as assigned.

Skills

Billing audit

Coding audit

Medical coding

AAPC CPC/COC

AHIMA CCS/RHIT/RHIA

SQL

Data analysis

Excel

Education

Bachelor's degree

4+ years commensurate experience

Tools

Excel

SQL

Job description

Oscar Health is hiring an Associate, Itemized Bill Reviewer to join our Payment Integrity team. This fully remote role supports accurate and timely claim payment through deep coding and billing expertise.

You will leverage OSCAR's claim infrastructure and cross-functional workflows to translate stakeholder friction into actionable improvements while reporting to the Manager, Payment Integrity (Pre-Pay).