Senior Specialist, Payment Policy

Oscar Health; United States; Hybrid; USD 62,000 - 92,000; Full time

Job summary

Oscar Health is seeking a Senior Specialist, Payment Policy to enhance payment policies through rigorous investigation and collaboration. This role requires expertise in claims processing and medical coding, with a focus on driving quality improvements. The position offers remote flexibility for candidates residing in various states, along with competitive pay and employee benefits. Join us to reshape healthcare delivery in American insurance.

Benefits

Unlimited vacation

Annual performance bonuses

Medical, dental, and vision benefits

401(k) plan participation

Paid parental leave

Qualifications

• Bachelor's degree or 4+ years experience.
• 3+ years in claims processing or health care operations.
• Medical coding certification is required.

Responsibilities

• Support payment policy activities and investigate payment policy issues.
• Respond to inquiries regarding policies and claims.
• Research and summarize coding rules to inform reimbursement policy.

Skills

Claims processing

Medical coding

Auditing

Problem solving

Education

Bachelor's degree

Medical coding certification

Job description

Join to apply for the Senior Specialist, Payment Policy role at Oscar Health

Join to apply for the Senior Specialist, Payment Policy role at Oscar Health

Hi, we're Oscar. We're hiring a Senior Specialist, Payment Policy to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a 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

The Senior Specialist, Payment Policy is responsible for supporting payment policy activities. This includes thorough investigation of payment policy issues. This is accomplished by leveraging a strong understanding of Oscar's claim infrastructure, processing, and payment integrity to effectively improve and enhance payment policies.

You will report to the Manager, Payment Policy.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change.

Pay Transparency

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $69,600 - $91,350 per year. The base pay for this role in all other locations is: $62,640 - $82,215 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
  
  

Qualifications

• A bachelor's degree or 4+ years of commensurate experience
• 3+ years of experience in claims processing, coding, auditing or health care operations
• 3+ years experience in medical coding
• 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 collaborating with internal and/or external stakeholders to improve business workflows and processes
  
  

Bonus Points

• 2+ years of experience working with large data sets using excel or a database language
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Experience using SQL
  
  

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

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.

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.

Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.

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 Notice to Job Applicants.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Information Technology

• Industries

  Insurance

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