Remote Itemized Bill Review Specialist

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

Job summary

Oscar Health in the United States is seeking an Associate, Payment Integrity, Itemized Bill Review (IBR) to join our Payment Integrity team. The role focuses on executing billing and coding expertise to ensure claims are paid accurately and timely, leveraging Oscar's claim infrastructure and cross-functional collaboration.

This remote position is open to candidates in specified metro areas with potential future hybrid options.

Qualifications

• Bachelor's degree or 4+ years of commensurate experience.
• 2+ years of bill / coding audit experience with a focus on hospital/facility billing (UB-04).
• 4+ years experience in medical coding.
• AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA) certification.

Responsibilities

• Perform line-by-line review of high-dollar facility itemized bills and corresponding claim forms.
• Identify and document potential billing errors including unbundling and non-covered services.
• Compare billed charges against contracts and industry guidelines to confirm billing practices.
• Apply knowledge of CPT, HCPCS, ICD-10, MS-DRGs to validate codes.
• Prepare clear documentation of findings and recommended adjustments.
• Support audit process improvements and act as SME on billing issues.

Skills

Billing audit

Medical coding

Data analysis

Education

Bachelor's degree or 4+ years experience

Tools

CPT/HCPCS/ICD-10 knowledge

Job description

Oscar Health in the United States is seeking an Associate, Payment Integrity, Itemized Bill Review (IBR) to join our Payment Integrity team. The role focuses on executing billing and coding expertise to ensure claims are paid accurately and timely, leveraging Oscar's claim infrastructure and cross-functional collaboration.

This remote position is open to candidates in specified metro areas with potential future hybrid options.