Senior Analyst, Payment Integrity

Hi, we're Oscar. We're hiring a Senior Analyst to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a 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 Senior Analyst, Payment Integrity role organizes, scopes, prepares, investigates and/or executes on solutions and process improvements within edits and ideation. 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.

You will report to the Senior Manager, Payment Integrity.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

This is a hybrid role in our Los Angeles, California office. You will work part of the time in the office and part of the time remote / work-from-home. #LI-Hybrid

Pay Transparency:

Responsibilities

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.


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


• Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.


• Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.


• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.


• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.


• 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

Qualifications

• A bachelor's degree or 4+ years of commensurate experience


• 3+ years of experience in claims processing, coding, auditing or health care claims operations


• 3+ years experience in medical coding within payment integrity


• 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.


• 2+ years experience deriving business insights from datasets and solving problems


• 1+ years experience improving business workflows and processes


• 1+ years experience collaborating with internal and/or external stakeholders

Bonus points

• 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)


• Process Improvement or Lean Six Sigma training


• Experience using SQL