Remote Payment Integrity Associate: Claims & Process

Oscar Health; Stati Uniti; Remoto; USD 83.000 - 109.000; Tempo pieno

Vantaggi offerti da questo lavoro

Unlimited vacation

Annual performance bonus

Healthcare benefits

Paid holidays

Descrizione del lavoro

Oscar Health is seeking an Associate to join our Payment Integrity team. This role supports process improvement and issue resolution in the Oscar claim environment for both Oscar Insurance and +Oscar clients, leveraging deep knowledge of claim infrastructure, workflows and data models to translate friction into actionable opportunities.

Reporting to the Senior Manager, Payment Integrity, this remote position is open to multiple metros and may evolve into a hybrid presence.

Competenze

• 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.
• 2+ years experience in a technical role or process improvement role (Six Sigma or similar).
• Process Improvement or Lean Six Sigma training.
• Experience using SQL.

Mansioni

• 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

Conoscenze

Claims processing

Coding

Auditing

Health care operations

Stakeholder collaboration

SQL

Data analysis

Process improvement

Formazione

Bachelor's degree or 4+ years experience

Strumenti

SQL

Descrizione del lavoro

Oscar Health is seeking an Associate to join our Payment Integrity team. This role supports process improvement and issue resolution in the Oscar claim environment for both Oscar Insurance and +Oscar clients, leveraging deep knowledge of claim infrastructure, workflows and data models to translate friction into actionable opportunities.

Reporting to the Senior Manager, Payment Integrity, this remote position is open to multiple metros and may evolve into a hybrid presence.