Remote Payment Integrity Associate

Oscar Health; Phoenix (AZ); Remote; USD 83,000 - 109,000; Full time

Job summary

Oscar Health is seeking an Associate, Payment Integrity to support process improvement and issue resolution within the Oscar claim environment. The role requires deep knowledge of claims, coding and reimbursement policies and involves cross-functional collaboration with internal teams.

The position is fully remote with potential future hub-based collaboration and offers base pay in the United States, with annual performance bonuses and benefits.

Qualifications

• Bachelor’s degree or 4+ years of commensurate experience.
• 4+ years of experience in claims processing, coding, auditing or health care operations.
• 4+ years experience in medical coding within payment integrity.
• 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.
• 2+ years experience deriving business insights from datasets and solving problems.
• 1+ years experience improving business workflows and processes.
• 1+ years experience collaborating with internal and/or external stakeholders.

Responsibilities

• Provide subject matter expertise and in-depth understanding of Payment Integrity internal claims processing edits, external vendor edits and Oscar reimbursement policies.
• 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. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Education

Bachelor's degree

Job description

Oscar Health is seeking an Associate, Payment Integrity to support process improvement and issue resolution within the Oscar claim environment. The role requires deep knowledge of claims, coding and reimbursement policies and involves cross-functional collaboration with internal teams.

The position is fully remote with potential future hub-based collaboration and offers base pay in the United States, with annual performance bonuses and benefits.