Senior Analyst, Payment Integrity

📋 Description

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research industry standard coding rules, summarize and provide input into reimbursement policy
• Use knowledge gained through research and claims review to ideate payment integrity opportunities.
• Ingest information from internal and external partners regarding adverse claim outcomes
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to

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

🎁 Benefits

• Medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance