Senior Policy Analyst
ZERO TO THREE
Senior Analyst, Payment Integrity
Oscar
full-time
Posted on:
Location Type: Remote
Location: Remote • Arizona, Florida, Texas • 🇺🇸 United States
Visit company websiteSalary
💰 $62,640 - $82,215 per year
Job Level
Senior
About the role
- Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.
- Respond to internal and external inquiries and disputes regarding policies and edits.
- Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
- Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
- Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
- Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
- Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
- Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements
- A bachelor's degree or 4+ years of commensurate experience
- 3+ years of experience in claims processing, coding, auditing or health care claims operations
- 3+ years 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/resolution practices.
- 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
Benefits
- Employee benefits
- Participation in Oscar's unlimited vacation program
- Annual performance bonuses
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims processingmedical codingauditingpayment integritydata miningroot cause analysisbusiness insightsworkflow improvementreimbursement methodologiesclaims resolution practices
Soft skills
collaborationcommunicationproblem solvingtransparencystakeholder management
Certifications
CPCCOCCCSRHITRHIA
