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 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

The Associate, Payment Integrity is responsible for  ensuring claims are paid accurately and timely with the highest quality. They are the subject matter expert for their team and a key member for payment policy creation and review processes. The Associate provides thought leadership for process and workflows that impact claims payments and works closely with Claims Optimization on execution of changes.

You will report to the Senior Director, Payment Integrity.

Work Location: 

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. 

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.  

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $93,600 - $122,850 per year. The base pay for this role in all other locations is: $84,240 - $110,565 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 Claims processing workflows.
• Assist in responding to inquiries regarding pre-pay edits from various stakeholders across the organization.
• Research coding rules and guidelines in support of internal and external pre-pay edits.
• Participate in the review of vendor edit performance, including but not limited to monthly quality audits.
• Provide coding expertise on reimbursement policy and prepay editing topics.
• Identify claims payment issues that require action and provide action steps needed to remediate the issue.
• Identify all claims with similar payment issues and Identification of claims paid incorrectly and creating the process to recover the incorrect payments.
• Represent claims in payment policy discussions and when necessary, document new policies or modifications to existing policies.
• Provide training and education to team members when necessary.
• Act as a subject matter expert using internal and external tools in order to complete audits and provide guidance to team members. 
• Act as an in-house expert on data structure and visualization for various stakeholders in service operations.
• Responsible for peer review of others within the team.
• Mediates errors with key stakeholders. 
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 3+ years of experience in claims processing, auditing or health care operations
• 3+ years experience experience in medical coding
• 2+ year(s) ability to work independently to drive projects to completion

Bonus Points

• Bachelor’s degree 
• 3+ years of related work experience in analytics or operations
• 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.
• Ability to execute on multiple high priority projects within tight deadlines