Senior Analyst, Payment Integrity

name; United States; Remote; USD 65,000 - 85,000; Full time

Job summary

Oscar Health is hiring a Senior Analyst, Payment Integrity to support improvements in the claim environment for Oscar and its clients. The role requires deep knowledge of Oscar’s claim infrastructure and cross-functional collaboration to translate friction into actionable improvements. You will report to the Senior Manager, Payment Integrity.

This is a remote role open to multiple U.S. metro areas with potential future hybrid work.

Qualifications

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

Responsibilities

• Contribute as SME for reimbursement policies and edits.
• Respond to inquiries and disputes regarding policies and edits.
• Research coding rules and summarize policy language.
• Translate research into business requirements for change.
• Ingest information from partners to scope and prioritize items.
• Identify opportunities from data mining and process monitoring.
• Keep stakeholders informed on progress and blockers.
• Support run state objectives with rapid research and analysis.
• Ensure compliance with applicable laws and regulations.
• Perform other duties as assigned.

Skills

Data analysis

Stakeholder collaboration

Process improvement

Claims processing knowledge

Medical coding understanding

Education

Bachelor’s degree

Medical coding certification (AAPC/AHIMA)

Tools

SQL

Job description

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
• 1+ years experience collaborating with internal and/or external stakeholders

Bonus points

• 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)
• Process Improvement or Lean Six Sigma training
• Experience using SQL

This is an authentic Oscar Health job opportunity.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We’re on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI)

Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation

Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.

California Residents

For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.