Associate, Payment Policy

Hi were Oscar. Were hiring a Payment Policy Associate 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 ourselvesone that behaves like a doctor in the family.

About the role:

The Payment Policy Associate manages and executes all payment policy activities including organizing scoping investigating and resolving payment policy issues. Responsibilities also involve delegating and prioritizing project tasks effectively. This work relies on internal team research and a thorough understanding of Oscars claim infrastructure to draft and update payment policies accurately.

You will report into the Manager Payment Policy.

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: $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 in-depth understanding of Payment Integrity internal claims processing edits external vendor edits and Oscar reimbursement policies.
• Analyze data mining and process monitoring to pinpoint claims payment issues then define the scope and steps for policy remediation.
• Examine industry standards to confirm claim payments align with industry best practices internal policies and regulationsboth industry-wide and Oscar-specific.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Document industry standard coding rules and draft recommendations on reimbursement policy language and scope.
• 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.
• Attend regulation update meetings and relay information to team members providing training and education as needed.
• 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 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
• 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
• Knowledge management training or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Experience using SQL