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 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 into the Senior 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.

Pay Transparency: The base pay for this role is: $82,717 - $108,566 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.
• 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.
• 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

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 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

Originally posted on Himalayas