Associate, Payment Integrity
New
O
Oscar HealthHealth insurance
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.Full-TimeEntry
Salary82,717 - 108,566 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- 4+ years of experience in claims processing, coding, auditing or health care operations; 4+ years experience in medical coding within payment integrity; 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.
- Required Skills
- SQLData Analysis
Requirements
- Bachelor’s degree or 4+ years of commensurate experience.
- 4+ years of experience in claims processing, coding, auditing, or health care operations.
- 4+ years of 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 and resolution practices.
- 2+ years of experience deriving business insights from datasets and solving problems.
- 1+ years of experience improving business workflows and processes.
- 1+ years of experience collaborating with internal and/or external stakeholders.
- Bonus: 2+ years of experience in a technical or process improvement role.
- Bonus: Process Improvement or Lean Six Sigma training.
- Bonus: Experience using SQL.
Responsibilities
- Provide expertise on 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 and translate them into business requirements for internal partners.
- Gather information about adverse claim outcomes and work with partners to scope, size, prioritize, and deliver solutions.
- Use partner submissions, data mining, and process monitoring to identify recurring opportunities and solve problems.
- Keep stakeholders informed of progress, status changes, blockers, and completion.
- Research escalated issues, perform root cause analysis, and provide training as assigned.
View Full Description & ApplyYou'll be redirected to the employer's site
