Associate, Payment Integrity

Oscar Health•Remote, AZ

1d•$82,717 - $108,566•Remote

About The Position

The Associate, Payment Integrity supports process improvement and issue resolution in Oscar’s claims environment for both Oscar Insurance and +Oscar clients. The role organizes, scopes, prepares, investigates, and executes solutions and process improvements related to claims edits and ideation. It relies on knowledge of Oscar’s claims infrastructure, workflows, tooling, platform logic, and data models to work cross-functionally and translate stakeholder friction into actionable opportunities. The position reports to the Senior Manager, Payment Integrity. This is a fully remote position open to candidates residing in Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; or Salt Lake City, Utah. Oscar notes that its work approach may adapt over time and could involve hybrid presence at the hub office associated with the employee’s metro area. The base pay range is $82,717–$108,566 per year. The role is eligible for employee benefits, participation in Oscar’s unlimited vacation program, and annual performance bonuses. Final offers within the range depend on relevant skills, education, and experience.

Requirements

A bachelor’s degree or at least 4 years of commensurate experience.
At least 4 years of experience in claims processing, coding, auditing, or health care operations.
At least 4 years of experience in medical coding within payment integrity.
Medical coding certification through AAPC (CPC or COC) or AHIMA (CCS, RHIT, or RHIA).
Experience with reimbursement methodologies, provider contract concepts, and common claims-processing and resolution practices.
At least 2 years of experience deriving business insights from datasets and solving problems.
At least 1 year of experience improving business workflows and processes.
At least 1 year of experience collaborating with internal and/or external stakeholders.

Nice To Haves

At least 2 years of experience in a technical role (such as QA analyst, PM, operations analyst, finance, consulting, or industrial engineering) or a process-improvement role (such as Six Sigma or similar).
Process Improvement or Lean Six Sigma training.
Experience using SQL.

Responsibilities

Provide subject matter expertise and in-depth understanding of internal claims-processing edits, external vendor edits, and Oscar reimbursement policies.
Respond to internal and external inquiries and disputes regarding policies and edits.
Document industry-standard coding rules and recommend reimbursement policy language and scope.
Identify payment integrity opportunities based on industry-standard coding rules, translate them into business requirements, and collaborate with internal partners to implement changes.
Gather information from internal and external partners about adverse claim outcomes; collaborate to scope, size, prioritize, and deliver solutions.
Use partner submissions, data mining, and process monitoring to proactively identify thematic opportunities and solve problems.
Keep stakeholders informed about progress, status changes, blockers, and completion, and answer questions as appropriate.
Support Oscar run-state objectives through timely research, root-cause analysis, and training when issues are escalated and assigned by leadership.
Comply with applicable laws and regulations.
Perform other duties as assigned.