Senior Analyst, Payment Integrity

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

📋 Description

• Assist in enhancing processes and resolving issues within the Oscar claim framework for both Oscar Insurance and +Oscar clients.

• Plan, organize, prepare, investigate, and/or implement solutions and improvements to processes related to edits and ideation.

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

• Act as a subject matter expert on reimbursement policies and both internal and external claims processing edits.

• Address inquiries and disputes from internal and external sources concerning policies and edits.

• Investigate industry-standard coding regulations and contribute to the development of reimbursement policy language and scope.

• Recognize payment integrity opportunities and translate them into actionable business requirements.

• Work together with internal and external partners to define, prioritize, and deliver solutions.

• Evaluate partner submissions, conduct data mining, and monitor processes to uncover opportunities.

• Keep stakeholders updated on progress, status changes, obstacles, and completions.

• Provide research, root cause analysis, and training for escalated matters.

• Adhere to relevant laws and regulations.

⛳️ Requirements

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

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

• 3+ years of experience in medical coding focused on payment integrity.

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

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

• 2+ years of experience in deriving business insights from datasets and solving related issues.

• 1+ years of experience in enhancing business workflows and processes.

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

🏝️ 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.

• Wellness reimbursements.