Associate, Payment Integrity
Associate, Payment Integrity
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$ 88800 - 116550
1 Vacancy
Job Description
Hi were Oscar. Were hiring an Associate 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 ourselvesone 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 Payment Integrity vendors. The Associate Payment Integrity is responsible for ensuring claims are paid accurately and timely by analyzing data and auditing existing policies and edits. This is accomplished by leveraging a deep understanding of Oscars claim infrastructure payment policies edit logic vendor specifications regulatory guidelines etc. to work crossfunctionally to understand and identify opportunities for improvement. The Associate provides thought leadership for Payment Integrity process and workflows that impact claims edits and logic and works closely with cross functional partners on execution of changes.
You will report to the Senior Manager Payment Integrity.
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 / workfromhome role.
You must reside in one of the following states: Alabama Arizona Arkansas California Colorado Connecticut Florida Georgia IllinoisIndiana 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. #LIRemote
Pay Transparency:
The base pay for this role in the states of California Connecticut New Jersey New York and Washington is: $88800 $116550 per year. The base pay for this role in all other locations is: $79920 $104895 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program and annual performance bonuses.
Responsibilities
- Provide subject matter expertise and indepth understanding of Payment Integrity internal claims processing edits external vendor edits Oscar reimbursement policies with a specialized focus on Anesthesia billing and coding.
- Identify claims payment issues from data mining process monitoring etc. provide scoping and action steps needed to remediate the issue.
- Respond to internal and external inquiries and disputes regarding policies and edits.
- Document industry standard coding rules and provide recommendations on reimbursement policy edit logic and creating and building exclusions.
- Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
- Provide training and education to team members when necessary.
- 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 bachelors degree or 4 years of commensurate experience
- 4 years of experience in claims processing coding auditing or health care operations
- 4 years experience in medical coding and deep understanding of Anesthesia coding guidelines
- 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.
- 3 year(s) ability to work independently to drive projects to completion
Bonus Points
- 3 years of experience working with large data sets using excel or a database language
- Experience coaching and training team members
- Experience in a professional healthcare claims organization
- 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 discriminationfree hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. Were 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. Fulltime 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 applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () 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.
Required Experience:
IC
Employment Type
Full-Time
