Payment Integrity Associate - Itemized Bill Review - Remote

Overview

An Associate, Itemized Bill Review will join Oscar's Payment Integrity team, focusing on ensuring accurate and timely claims payments through billing and coding expertise.

In Short

• Perform line-by-line review of high-dollar facility itemized bills.
• Identify and document potential billing errors.
• Compare billed charges against contracts and guidelines.
• Validate accuracy of codes used for services billed.
• Prepare documentation of findings and recommended claim adjustments.
• Contribute to refining internal audit processes.
• Serve as a subject matter expert for billing issues.
• Provide training and education to team members.
• Support Oscar run state objectives.
• Compliance with applicable laws and regulations.

Requirements

• Bachelor's degree or 4+ years of experience.
• 2+ years of bill/coding audit experience.
• 4+ years experience in medical coding.
• Medical coding certification (CPC, COC, CCS, RHIT, RHIA).
• Experience with reimbursement methodologies and claims processing.

Benefits

• Participation in unlimited vacation program.
• Annual performance bonuses.
• Medical, dental, and vision benefits.
• Paid holidays and sick time.
• 401(k) plan participation.
• Life and disability insurance.
• Paid wellness time and reimbursements.