Remote opportunity at
OSCAR ASSOCIATES (AMERICAS), LLCAssociate, Payment Integrity
OSCAR ASSOCIATES (AMERICAS), LLC is hiring an Associate, Payment Integrity to work remotely. Eligible locations for this position include Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville,…
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About This Role
OSCAR ASSOCIATES (AMERICAS), LLC is hiring an Associate, Payment Integrity to work remotely. Eligible locations for this position include Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; and Salt Lake City, Utah, with the possibility of future hybrid models at hub offices. This position reports to the Senior Manager, Payment Integrity. Founded in 2012, Oscar operates as a health insurance company built around a full-stack technology…
Job Description
OSCAR ASSOCIATES (AMERICAS), LLC is hiring an Associate, Payment Integrity to work remotely. Eligible locations for this position include Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; and Salt Lake City, Utah, with the possibility of future hybrid models at hub offices. This position reports to the Senior Manager, Payment Integrity.
Founded in 2012, Oscar operates as a health insurance company built around a full-stack technology platform with the goal of functioning like a doctor in the family. The person in this role will handle process improvements, issue resolution, and solution scoping for both Oscar Insurance and +Oscar clients. Responsibilities involve analyzing claim structures, translating friction into improvement opportunities, collaborating across departments, and responding to inquiries regarding reimbursement policies and processing edits.
This position suits professionals with a background in medical coding, claims processing, and healthcare operations who want to contribute to transforming health care.
Responsibilities
- Provide subject matter expertise on internal claims processing edits, external vendor edits, and reimbursement policies
- Respond to inquiries and disputes related to policies and edits from internal and external sources
- Document industry-standard coding rules and recommend reimbursement policy scope and language
- Ideate payment integrity opportunities using knowledge of coding rules and translate them into business requirements
- Collaborate with internal partners to deliver solutions and process changes
- Ingest partner information regarding adverse claim outcomes to scope, prioritize, and solve issues
- Analyze data mining insights and monitoring data to proactively spot thematic areas for improvement
- Communicate progress and status updates to stakeholders transparently
- Support run state objectives by providing research, root cause analysis, and training on escalated issues
- Comply with all relevant laws and regulations
Requirements
- A bachelor degree or four or more years of commensurate experience
- At least 4 years of experience in claims processing, coding, auditing, or health care operations
- At least 4 years of experience in medical coding focused on payment integrity
- Experience with reimbursement methodologies, provider contracts, and claims resolution practices
- At least 2 years of experience analyzing datasets to derive business insights and solve problems
- At least 1 year of experience improving business workflows and processes
- At least 1 year of experience collaborating with internal or external stakeholders
- Residency in Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; or Salt Lake City, Utah
Qualifications
- Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
- Two or more years of experience in a technical role such as QA analyst, project manager, operations analyst, finance, consulting, or industrial engineering
- Experience in a process improvement role utilizing methodologies like Six Sigma
- Training in process improvement or Lean Six Sigma
- Experience utilizing SQL
Core Skills
Benefits
- Participation in Oscar unlimited vacation program
- Annual performance bonuses
- Medical, dental, and vision insurance coverage
- 11 paid holidays
- Paid sick time
- Paid parental leave
- Participation in a 401(k) plan
- Life and disability insurance
- Paid wellness time and wellness reimbursements
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, this is a remote position open to candidates residing in Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; and Salt Lake City, Utah. Future work models may potentially introduce a hybrid presence at a local hub office.
What is the salary range for the Associate, Payment Integrity role?
The base pay for this role ranges from $82,717 to $108,566 per year, with final offers determined by relevant skills, education, and experience. Employees are also eligible for annual performance bonuses.
What certifications are required for this job?
Candidates must hold a medical coding certification through AAPC, such as CPC or COC, or through AHIMA, such as CCS, RHIT, or RHIA.
How do I request accommodations for the application process?
Applicants who require reasonable accommodations during the application process can contact the Oscar Benefits Team directly via email at accommodations@hioscar.com.
Sample Interview Questions
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