Remote Senior Analyst, Payment Integrity & Improvements

Oscar Health; États-Unis; À distance; USD 65 000 - 85 000; Plein temps

Avantages offerts par ce poste

Unlimited vacation

Annual bonus

Medical benefits

Dental & vision benefits

401(k) plan

Paid holidays

Résumé du poste

Oscar Health is hiring a Senior Analyst to join the Payment Integrity team. This role supports process improvement and issue resolution in the Oscar claim environment for both the Oscar Insurance business and +Oscar clients. The Senior Analyst, Payment Integrity translates stakeholder friction into actionable opportunities for improvement.

You will report to the Senior Manager, Payment Integrity. This fully remote role is open to candidates nationwide with potential future hub presence in your

Qualifications

• Bachelor's degree or 4+ years of commensurate experience.
• 4+ years of experience in claims processing, coding, auditing or health care operations.
• 3+ 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.

Responsabilités

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
• Use knowledge gained through research and claims review to ideate payment integrity opportunities. 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

Connaissances

Claims processing

Medical coding

Data insights

Stakeholder collaboration

Formation

Bachelor's degree or 4+ years experience

Outils

SQL

Description du poste

Oscar Health is hiring a Senior Analyst to join the Payment Integrity team. This role supports process improvement and issue resolution in the Oscar claim environment for both the Oscar Insurance business and +Oscar clients. The Senior Analyst, Payment Integrity translates stakeholder friction into actionable opportunities for improvement.

You will report to the Senior Manager, Payment Integrity. This fully remote role is open to candidates nationwide with potential future hub presence in your