Senior Analyst, Payment Integrity

pofft; Northern (KY); Hybrid; USD 65,000 - 85,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Benefits

Job summary

Oscar is hiring a Senior Analyst to support Payment Integrity by improving reimbursement policies, edits, and workflows. The role requires deep knowledge of Oscar's claim infrastructure and cross-functional collaboration to translate stakeholder friction into actionable improvements.

Responsibilities include researching coding rules, analyzing data for opportunities, and delivering solutions with partners. This is a flexible remote position with potential hybrid future options.

Qualifications

• Bachelor's degree or 4+ years of commensurate experience.
• Medical coding certification through AAPC or AHIMA.

Responsibilities

• Contribute as SME for reimbursement policies and internal/external edits.
• Respond to inquiries and disputes regarding policies and edits.
• Research coding rules and reimbursement policy language.
• Translate insights into business requirements and drive changes.
• Collaborate with partners to scope and deliver solutions.

Skills

Claims processing

Medical coding

Data analysis

Process improvement

Stakeholder collaboration

Education

Bachelor's degree or 4+ years of commensurate experience

Medical coding certification (AAPC CPC/COC) or AHIMA CCS/RHIT/RHIA

Job description

Senior Analyst, Payment Integrity - Flexible / Remote

Hi, we're Oscar.
We're hiring a Senior Analyst to join our Payment Integrity team.
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members.
We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

This role is responsible for supporting process improvement and issue resolution in the Oscar claim environment for both the Oscar Insurance business and +Oscar clients.
The Senior Analyst, Payment Integrity role organizes, scopes, prepares, investigates and/or executes on solutions and process improvements within edits and ideation.
This is accomplished by leveraging a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement.
You will report into the Senior Manager, Payment Integrity.

Work Location

This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah.
You will be fully remote; however, our approach to work may adapt over time.
Future models could potentially involve a hybrid presence at the hub office associated with your metro area.
#LI-Remote

Pay Transparency

The base pay for this role is: $64,832 - $85,092 per year.
You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• 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

Requirements

• A 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
• ...