Payment Integrity Coding Associate

Summary

Join Oscar's Payment Integrity team as a Coding Associate and support the improvement of dispute processes and issue resolution within Oscar's payment integrity environment. Leverage your understanding of Oscar's claim infrastructure and workflows to collaborate with cross-functional teams. Translate stakeholder friction into actionable improvement opportunities and provide thought leadership for Payment Integrity processes. You will conduct in-depth medical record reviews, apply industry standard coding rules, and ideate payment integrity opportunities. This role requires a deep understanding of medical coding and claims processing, and involves working with large datasets. The position offers a blended work culture with remote options and competitive compensation and benefits.

Requirements

• A bachelor’s degree or 4+ years of commensurate experience
• 4+ years of experience in claims processing, coding, auditing or health care operations
• 4+ years of 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
• 3+ year(s) ability to work independently to drive projects to completion
• 3+ years of experience working with large data sets using excel or a database language

Responsibilities

• Provide subject matter expertise and in-depth understanding of Payment Integrity internal claims processing edits, external vendor edits and Oscar reimbursement policies
• Identify payment integrity dispute issues from data mining, process monitoring, etc., provide scoping and action steps needed to remediate the issue
• Conduct in depth medical record reviews and respond to internal inquiries and disputes regarding policies and edits
• Apply industry standard coding rules to dispute review and provide recommendations on reimbursement policy language and scope
• Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules. Translate into business requirements; submit to and collaborate with internal partners to effectuate change
• Provide training and education to team members when necessary
• 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

Preferred Qualifications

• Experience in a professional healthcare claims organization
• Knowledge management, training, or content development in operational settings
• Process Improvement or Lean Six Sigma training
• Experience using SQL

Benefits

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