Associate, Payment Integrity

Hi, we're Oscar. We're hiring an 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 ourselves—one that behaves like a doctor in the family.

About the role:

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. This is accomplished by leveraging a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement. The Associate provides thought leadership for Payment Integrity process and workflows that impact claims payments and works closely with cross functional partners on execution of changes.

You will report into the Sr. Manager, Payment Integrity.

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: $79,920 - $104,895 per year. You are also eligible for employee benefits, participation in Oscar's 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.


• Identify claims payment issues from data mining, process monitoring, etc., provide scoping and action steps needed to remediate the issue.


• Respond to internal and external inquiries and disputes regarding policies and edits.


• Document industry standard coding rules and provide 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.


• Provide training and education to team members when necessary.


• 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 bachelor's 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 experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)


• 3+ years of experience working with large data sets using excel or a database language


• Experience in a professional healthcare claims organization


• Knowledge management, training, or content development in operational settings


• Process Improvement or Lean Six Sigma training


• Experience using SQL