Associate, Payment Integrity - Remote

Overview

This role is responsible for supporting process improvement and issue resolution in the Oscar claim environment for both the Oscar Insurance business and +Oscar clients. The Associate, Payment Integrity is responsible for ensuring claims are paid accurately and timely with the highest quality.

In Short

• Provide subject matter expertise in Payment Integrity internal claims processing edits.
• Identify claims payment issues and provide scoping and action steps needed to remediate them.
• Respond to internal and external inquiries regarding policies and edits.
• Document industry standard coding rules and provide recommendations.
• Ideate payment integrity opportunities based on industry knowledge.
• Provide training and education to team members.
• Maintain transparency and collaboration with stakeholders.
• Support Oscar run state objectives by providing research and analysis.
• Comply with all applicable laws and regulations.
• Other duties as assigned.

Requirements

• A bachelor's degree or 4+ years of commensurate experience.
• 4+ years of experience in claims processing, coding, or auditing.
• 4+ years experience in medical coding.
• 3+ years of experience working with large data sets.
• Medical coding certification through AAPC or AHIMA.
• Experience with reimbursement methodologies and claims processing practices.

Benefits

• Eligible for employee benefits.
• Participation in Oscar's unlimited vacation program.
• Annual performance bonuses.