- Support process improvement and issue resolution in the Oscar claim environment for Oscar Insurance and +Oscar clients
- Organize, scope, prepare, investigate and/or execute solutions and process improvements within edits and ideation
- Leverage Oscar’s claim infrastructure, workflows, workflow tooling, platform logic and data models
- Contribute as a subject matter expert for reimbursement policies and internal and external claims processing edits
- Respond to internal and external inquiries and disputes regarding policies and edits
- Research industry standard coding rules and provide input into reimbursement policy language and scope
- Identify payment integrity opportunities and translate them into business requirements
- Collaborate with internal and external partners to scope, prioritize and deliver solutions
- Analyze partner submissions, data mining and process monitoring to identify opportunities
- Keep stakeholders informed of progress, status changes, blockers and completion
- Provide research, root cause analysis and training for escalated issues
- Comply with applicable laws and regulations
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
Core Competencies
Demonstrates expertise in medical coding and claims processing, with a strong focus on payment integrity and reimbursement methodologies. Proven ability to analyze data, improve workflows, and collaborate effectively with stakeholders to deliver solutions.
Highest-signal resume keywords
- Medical Coding Certification
- Claims Processing Experience
- Payment Integrity Expertise
- Data Analysis Skills
- Workflow Improvement Experience
ATS Optimization Keywords
Hard Skills
- Claims Processing
- Medical Coding
- Auditing
- Data Analysis
- Process Improvement
- Reimbursement Methodologies
- Business Insights Derivation
- Root Cause Analysis
- Issue Resolution
- Stakeholder Collaboration
Soft Skills
- Communication
- Problem-Solving
- Organizational Skills
- Training Ability
- Collaboration
Certifications & Qualifications
- CPC
- COC
- CCS
- RHIT
- RHIA
Industry Keywords
- Health Care Operations
- Reimbursement Policies
- Coding Rules
- Payment Integrity
- Claims Processing Edits
Tools & Technologies
- Workflow Tooling
- Data Models
- Claim Infrastructure
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Senior Analyst, Payment Integrity Arbeitgeber: Oscar Health
Oscar ist ein hervorragender Arbeitgeber, der sich durch eine innovative Unternehmenskultur und ein starkes Engagement für die Gesundheit seiner Mitglieder auszeichnet. Als Teil des Clinical Concierge Teams haben Sie die Möglichkeit, in einem dynamischen, technologiegetriebenen Umfeld zu arbeiten, das auf persönliche Entwicklung und Teamarbeit Wert legt. Mit umfassenden Mitarbeiterbenefits, flexiblen Arbeitsbedingungen und der Chance, einen echten Unterschied im Leben der Menschen zu machen, ist Oscar der ideale Ort für engagierte Pflegekräfte.
