Remote opportunity at
OSCAR ASSOCIATES (AMERICAS), LLCItemized Bill Reviewer
Oscar Associates (Americas), LLC is hiring an Itemized Bill Reviewer to join its Payment Integrity team. Founded in 2012, the health insurance company operates around a…
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About This Role
Oscar Associates (Americas), LLC is hiring an Itemized Bill Reviewer to join its Payment Integrity team. Founded in 2012, the health insurance company operates around a technology platform and aims to deliver member-focused coverage. This fully remote position is open to individuals residing in the United States, excluding Alaska, Delaware, Hawaii, Louisiana, Montana, North Dakota, Oklahoma, West Virginia, Wyoming, and U.S. Territories. Daily tasks are performed from a home office,…
Job Description
Oscar Associates (Americas), LLC is hiring an Itemized Bill Reviewer to join its Payment Integrity team. Founded in 2012, the health insurance company operates around a technology platform and aims to deliver member-focused coverage. This fully remote position is open to individuals residing in the United States, excluding Alaska, Delaware, Hawaii, Louisiana, Montana, North Dakota, Oklahoma, West Virginia, Wyoming, and U.S. Territories. Daily tasks are performed from a home office, though occasional travel for company events and team gatherings is required. The base salary ranges from $91,908 to $120,629 per year for locations in California, Connecticut, New Jersey, New York, and Washington, and $82,717 to $108,566 per year for all other regions. Additional compensation includes annual performance bonuses, access to an unlimited vacation program, and employee benefits.
The Itemized Bill Reviewer executes internal payment integrity solutions while ensuring claims are processed accurately, timely, and with high quality. The professional in this role leverages a deep understanding of platform workflows, claim infrastructure, and data models to translate stakeholder friction into actionable enhancements. Responsibilities include conducting line-by-line analyses of high-dollar facility bills, documenting billing errors like unbundling or duplicate charges, and comparing costs against contracts and industry standards. This role reports to the Manager of Payment Integrity (Pre-Pay) and requires collaboration across departments to resolve disputes, review policies, and support operational goals.
Responsibilities
- Perform line-by-line reviews of high-dollar facility itemized bills and related claim forms like UB-04s
- Identify and document billing errors, including duplicate charges, unbundling, and non-rendered services
- Compare billed charges against payor contracts and industry guidelines
- Apply coding knowledge including CPT, HCPCS, ICD-10, and MS-DRGs to validate billing accuracy
- Review claims under specific reimbursement scenarios such as percentage of charges or stop-loss levels
- Prepare documentation of findings, savings, policy violations, and recommended claim adjustments
- Contribute to internal audit process and tool improvements
- Act as a subject matter expert on billing issues, coding guidelines, and reimbursement policies
- Identify claims payment issues through data mining and process monitoring to provide scoping and remediation steps
- Respond to inquiries and disputes regarding edits and policies while documenting coding rules
- Ideate payment integrity opportunities and collaborate with internal partners to enact change
- Provide training and education to team members and support leadership during escalations
Requirements
- A bachelor’s degree or at least 4 years of commensurate experience
- Minimum 2 years of bill or coding audit experience focused on hospital or facility billing
- Minimum 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 resolution practices
- Compliance with applicable laws and regulations
Qualifications
- 3+ years of experience working with large data sets using Excel or a database language
- Knowledge management, training, or content development experience in operational settings
- Process improvement or Lean Six Sigma training
- Experience using SQL
Core Skills
Benefits
- Medical, dental, and vision benefits
- Participation in an unlimited vacation program
- Annual performance bonuses
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life and disability insurance
- Paid wellness time and reimbursements
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
What is the remote work policy for this position?
This is a fully remote role completed from your home office. It is open to candidates residing in the U.S., excluding Alaska, Delaware, Hawaii, Louisiana, Montana, North Dakota, Oklahoma, West Virginia, Wyoming, and U.S. Territories. Occasional travel for team meetings and company events is required.
What is the salary range for the Itemized Bill Reviewer role?
The base pay for candidates in California, Connecticut, New Jersey, New York, and Washington is $91,908 to $120,629 per year. For all other locations, the base pay ranges from $82,717 to $108,566 per year. Final offers depend on skills, education, and experience, and employees are also eligible for annual performance bonuses.
What are the core educational and certification requirements?
Applicants must hold either a bachelor's degree or have at least four years of commensurate experience. Additionally, candidates need a minimum of four years of medical coding experience, two years of bill or coding audit experience focused on hospital or facility billing, and a medical coding certification through AAPC or AHIMA.
What type of employment is this?
The posting specifies that this is a full-time employment opportunity.
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