Associate, Payment Integrity Disputes - Remote

Overview

The Associate, Payment Integrity Disputes plays a crucial role in improving dispute processes and resolving issues within Oscar's payment integrity team.

In Short

• Support disputes process improvement and issue resolution.
• Review and resolve disputes accurately and timely.
• Collaborate cross-functionally to translate stakeholder friction into actionable improvements.
• Provide thought leadership for Payment Integrity processes impacting claims payments.
• Conduct in-depth medical record reviews.
• Apply industry coding rules to dispute reviews.
• Provide training and education to team members.
• Maintain transparency and communication with stakeholders.
• Support Oscar's objectives through research and analysis.
• Ensure compliance with applicable laws and regulations.

Requirements

• Bachelor’s degree or 4+ years of relevant experience.
• 4+ years in claims processing, coding, auditing, or healthcare operations.
• 4+ years of medical coding experience.
• Medical coding certification (AAPC or AHIMA).
• Experience with reimbursement methodologies and claims processing practices.
• 3+ years of independent project management experience.
• 3+ years working with large data sets using Excel or database languages.

Benefits

• Eligible for employee benefits including medical, dental, and vision.
• Participation in unlimited vacation program.
• Annual performance bonuses.
• 401(k) plan participation.
• Paid parental leave and wellness time.