Senior Analyst, Payment Integrity Disputes - Remote

Overview

Oscar is hiring a Senior Analyst, Payment Integrity Disputes to join our Disputes team. You will be responsible for supporting payment integrity disputes and issue resolution in the Oscar claim environment.

In Short

• Contribute as a subject matter expert for reimbursement policies and payment integrity disputes.
• Respond to inquiries and disputes regarding policies and edits.
• Research coding rules and provide input into reimbursement policy.
• Identify payment integrity opportunities and collaborate with partners.
• Conduct root cause analysis and provide solutions for claim outcomes.
• Keep stakeholders informed of progress and status changes.
• Support objectives by providing research and training as needed.
• Ensure compliance with applicable laws and regulations.
• Perform other duties as assigned.

Requirements

• Experience in Payment Integrity focused on Disputes and/or appeals.
• 4+ years of experience in claims processing or health care operations.
• 3+ years experience in medical coding.
• Medical coding certification through AAPC or AHIMA.
• Experience with reimbursement methodologies and claims processing practices.
• 2+ years experience deriving business insights from datasets.
• 1+ years experience improving business workflows.
• 1+ years experience collaborating with stakeholders.

Benefits

• Eligible for employee benefits and unlimited vacation program.
• Annual performance bonuses.
• Medical, dental, and vision benefits.
• 11 paid holidays and paid sick time.
• Paid parental leave and 401(k) participation.
• Life and disability insurance.
• Paid wellness time and reimbursements.