Senior Analyst, Payment Integrity Disputes
New
O
OscarHealth Insurance
Remote, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, UtahFull-TimeSenior
Salary$64,832 - $85,092 per year
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Job Details
- Experience
- 4+ years of experience in claims processing, coding, auditing or health care operations
- Required Skills
- Business AnalysisData AnalysisProcess improvement
Requirements
- 4+ years of experience in claims processing, coding, auditing or health care operations
- 3+ 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
- 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 external stakeholders
Responsibilities
- Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity disputes, 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.
- Translate business requirements into actionable payment integrity opportunities.
- Collaborate with internal and external partners to scope, size, prioritize, and deliver solutions to adverse claim outcomes.
- Identify thematic areas of opportunity through data mining and process monitoring.
- Maintain stakeholder transparency regarding project status and blockers.
- Support run state objectives through research, root cause analysis, and training as assigned.
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