Associate, Payment Integrity

Job not on LinkedIn

🔥 0 minutes ago

🌽 Illinois, Kentucky, +4 more states – Remote

🌽 Illinois – Remote 🐎 Kentucky – Remote ❄️ Minnesota – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote ⛷️ Utah – Remote

💵 $82.7k - $108.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

🔥 Funding within the last year

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Perform line-by-line review of high-dollar facility itemized bills and corresponding claim forms, such as UB-04s • Identify and document potential billing errors, including duplicate billing, improper unbundling, and charges for non-covered or non-rendered services • Compare billed charges against payor-specific contracts and industry guidelines • Apply coding systems to validate the accuracy of codes used for billed services • Review claims under specific reimbursement scenarios and minimum payor dollar thresholds • Document findings, savings identified, policy violations, and recommended claim adjustments • Refine internal audit processes and tools • Serve as a subject matter expert on complex billing issues, coding guidelines, and payor policies • Provide expertise on claims processing edits, vendor edits, and Oscar reimbursement policies • Identify claims payment issues through data mining and process monitoring; scope remediation actions • Respond to inquiries and disputes regarding policies and edits • Document coding rules and recommend reimbursement policy language and scope • Develop payment integrity opportunities, translate them into business requirements, and collaborate with internal partners • Provide training and education to team members • Keep stakeholders informed of progress, status changes, blockers, and completion • Support escalated issues through research, root cause analysis, and training • Comply with applicable laws and regulations • Perform other duties as assigned

🎯 Requirements

• A bachelor's degree or 4+ years of commensurate experience • 2+ years of bill / coding audit experience with a focus on hospital or facility billing (UB-04) • 4+ years experience in medical coding • 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 • Knowledge of national coding systems including CPT, HCPCS, ICD-10, and MS-DRGs • Candidates must reside in Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; or Salt Lake City, Utah

🏖️ Benefits

• Employee benefits • Oscar's 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