Associate, Payment Integrity

This is a fully remote position, open to applicants in Illinois, +5 more states.

📋 Description

• Assist in enhancing processes and resolving issues in the Oscar claim environment for Oscar Insurance and +Oscar clients

• Organize, define, prepare, investigate, and/or implement solutions and process enhancements within edits and ideation

• Utilize Oscar’s claims infrastructure, workflows, workflow tools, platform logic, and data models

• Collaborate across functions to convert stakeholder challenges into actionable improvement opportunities

• Offer subject matter expertise on Payment Integrity claims processing edits, external vendor edits, and Oscar reimbursement policies

• Address internal and external inquiries and disputes concerning policies and edits

• Document industry-standard coding rules and suggest reimbursement policy language and scope

• Generate payment integrity opportunities, translate them into business requirements, and work with internal partners to implement changes

• Gather partner information on adverse claim outcomes; scope, prioritize, and deliver solutions

• Employ partner submissions, data analysis, and process monitoring to pinpoint thematic opportunities

• Keep stakeholders updated on progress, status changes, obstacles, and completion

• Conduct research, root cause analysis, and provide training for escalated issues

• Adhere to all relevant laws and regulations

• Perform additional duties as assigned

⛳️ Requirements

• A bachelor’s degree or 4+ years of equivalent experience

• 4+ years of experience in claims processing, coding, auditing, or healthcare operations

• 4+ years of experience in medical coding within payment integrity

• Medical coding certification from AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)

• Familiarity with reimbursement methodologies, provider contract concepts, and common claims processing/resolution practices

• 2+ years of experience deriving business insights from datasets and solving problems

• 1+ years of experience enhancing business workflows and processes

• 1+ years of experience collaborating with internal and/or external stakeholders

• Process Improvement or Lean Six Sigma training is a plus

• Experience with SQL is a plus

🏝️ Benefits

• Employee benefits

• Unlimited vacation program

• Annual performance bonuses

• Medical benefits

• Dental benefits

• Vision benefits

• 11 paid holidays

• Paid sick time

• Paid parental leave

• 401(k) plan participation

• Life insurance

• Disability insurance

• Paid wellness time and reimbursements