Itemized Bill Reviewer

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $82.7k - $108.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $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

• Execute internal payment integrity solutions requiring billing and coding expertise • Review high-dollar facility itemized bills and corresponding claim forms line by line • Identify and document billing errors, duplicate billing, improper unbundling, and charges for non-covered or non-rendered services • Compare billed charges against payor-specific contracts and industry guidelines • Apply national coding systems to validate service codes • Review claims under specific reimbursement scenarios and stop-loss thresholds • Document findings, savings, policy violations, and recommended claim adjustments • Refine internal audit processes and tools • Serve as a subject matter expert on billing issues, coding guidelines, and payor policies • Identify payment issues through data mining and process monitoring, and define remediation actions • Respond to policy and edit inquiries and disputes • Document coding rules and recommend reimbursement policy language and scope • Develop payment integrity opportunities into business requirements and collaborate with internal partners • Train and educate team members • Keep stakeholders informed of progress, blockers, and status changes • Support escalated issues through research and root cause analysis • 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 • Bonus: 3+ years of experience working with large data sets using Excel or a database language • Bonus: Knowledge management, training, or content development in operational settings • Bonus: Process Improvement or Lean Six Sigma training • Bonus: Experience using SQL

🏖️ 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 and reimbursements • Occasional travel for team meetings and company events