Senior Payment Integrity Analyst - Remote

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

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.