Remote Itemized Bill Review Associate – Payment Integrity

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

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Benefits package

Job summary

Oscar Health is hiring an Associate, Itemized Bill Review (IBR) to join our Payment Integrity team. You will execute internal payment integrity solutions requiring billing and coding expertise and work cross-functionally to translate friction into actionable improvements.

You will report into the Manager, Payment Integrity (Pre-Pay). This is a remote position open to multiple US cities, with future hybrid possibilities and competitive pay transparency.

Qualifications

• Bachelor's degree or 4+ years of commensurate experience.
• 2+ years of bill / coding audit experience with hospital or facility billing (UB-04).
• 4+ years of medical coding experience.
• Medical coding certification through AAPC or AHIMA.
• Experience with reimbursement methodologies and claims processing 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 claim forms.
• Identify and document potential billing errors and improper unbundling.
• Compare billed charges against contracts and guidelines to confirm proper billing.
• Apply knowledge of CPT, HCPCS, ICD-10, MS-DRGs to validate codes.
• Review claims under specific reimbursement scenarios and thresholds.
• Document findings, including savings identified and recommended adjustments.
• Refine internal audit processes and tools for efficiency and accuracy.
• Serve as SME for internal and external stakeholders on billing issues and policies.
• Provide training and education to team members when necessary.
• Communicate progress and blockers to stakeholders; respond to inquiries.
• Support state objectives with rapid research and root-cause analysis.
• Comply with applicable laws and regulations.

Skills

Bill/Coding audit

Hospital billing

Medical coding

SQL

Excel

Data analysis

Communication

Education

Bachelor's degree or 4+ years of commensurate experience

AAPC CPC/COC or AHIMA CCS RHIT RHIA certification

Tools

SQL

Excel

Job description

Oscar Health is hiring an Associate, Itemized Bill Review (IBR) to join our Payment Integrity team. You will execute internal payment integrity solutions requiring billing and coding expertise and work cross-functionally to translate friction into actionable improvements.

You will report into the Manager, Payment Integrity (Pre-Pay). This is a remote position open to multiple US cities, with future hybrid possibilities and competitive pay transparency.