Note: The job is a remote job and is open to candidates in USA. Oscar is a health insurance company built around a full-stack technology platform and a focus on serving its members. The Senior Analyst, Payment Integrity supports process improvement and issue resolution in Oscar's claims environment by researching payment policies, analyzing claims-related issues, translating opportunities into business requirements, and collaborating with internal and external stakeholders.
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
Skills
- A bachelor's degree or 4+ years of commensurate experience
- 4+ years of experience in claims processing, coding, auditing or health care 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
- 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
Benefits
- Employee benefits
- Oscar's unlimited vacation program
- Annual performance bonuses
- Medical, dental, and vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life and disability insurance
- Paid wellness time and reimbursements
Company Overview
Company H1B Sponsorship