COB Specialist, Payment Integrity
New
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OscarHealth 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-TimeMiddle
SalaryThe base pay for this role is: $64,832 - $85,092 per year. You are also eligible for annual performance bonuses.
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Job Details
- Experience
- 4+ years of experience in payment integrity, ideally coordination of benefits; 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 AnalysisMicrosoft Excel
Requirements
- Have a bachelor's degree or 4+ years of commensurate experience.
- Have 4+ years of experience in payment integrity, ideally including coordination of benefits.
- Understand coordination of benefits reimbursement methodologies, provider contract concepts, and common claims processing and resolution practices.
- Have 2+ years of experience deriving business insights from datasets and solving problems.
- Have 1+ years of experience improving business workflows and processes.
- Have 1+ years of experience collaborating with internal and/or external stakeholders.
- Bonus: Have 2+ years of experience working with large datasets using Excel or a database language, preferably SQL.
- Bonus: Have experience with pharmacy coordination of benefits.
- Bonus: Have experience in a professional healthcare claims organization.
- Bonus: Have knowledge management, training, or content development experience in operational settings.
Responsibilities
- Support Coordination of Benefits efforts for Payment Integrity by investigating and verifying proper payment of medical and pharmacy claims.
- Create new COB workflows, enhance existing workflows, and drive COB audits.
- Serve as a subject matter expert on Oscar's COB reimbursement policies.
- Respond to internal and external inquiries and disputes regarding COB policies.
- Research claims and use findings to identify COB opportunities, translate them into business requirements, and collaborate with internal partners to implement changes.
- Review adverse claim outcomes with partners, scope and prioritize issues, and deliver COB solutions.
- Use partner submissions and process monitoring to identify thematic opportunities to solve COB problems.
- Keep stakeholders informed of progress, status changes, blockers, and completion.
- Provide research, root cause analysis, and training for escalated issues assigned by leadership.
- Analyze payment issues and investigate whether Oscar members have dual coverage.
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