Senior Analyst, Payment Integrity

Hi, we're Oscar. We're hiring a Senior Analyst to join our Payment Integrity team. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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

: This role is responsible for supporting process improvement and issue resolution in the Oscar claim environment for both the Oscar Insurance business and +Oscar clients. The Senior Analyst, Payment Integrity role organizes, scopes, prepares, investigates and/or executes on solutions and process improvements within edits and ideation. This is accomplished by leveraging a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement.

You will report into the Senior Manager, Payment Integrity. Work Location: 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. You will be fully remote; however, our approach to work may adapt over time.

Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote Pay Transparency: The base pay for this role is: $64,832 - $85,092 per year. You are also eligible for employee

Benefits

, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: - 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 - 4+ years of experience in claims processing, coding, auditing or health care 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 Bonus points: - 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar) - Process Improvement or Lean Six Sigma training - Experience using SQL This is an authentic Oscar Health job opportunity. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support.

We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for

Benefits

including: medical, dental, and vision

Benefits

, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their

Qualifications

, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar

Benefits

Team (a***s@***.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy . Apply directly on RemoteJobs.org: https://remotejobs.org/remote-jobs/senior-analyst-payment-integrity-oscar-health