Description

You will support issue resolution in the Oscar claim environment by managing end-to-end claims repayment quality, process improvement, and root cause analysis. You'll develop expertise in coding guidelines and perform audits to ensure billing accuracy, documenting findings clearly for non-clinical stakeholders.

Requirements

• 1+ years coding or auditing experience across multiple specialties
• Certified Professional Coder (CPC) or similar certification
• Bachelor's degree or 4+ years work experience
• Health insurance experience with claims, billing, or provider contracting

Responsibilities

• Develop expertise in CPT, HCPCS, ICD-10 coding and insurance billing requirements
• Perform prepayment and post-payment audits of medical records and claims
• Document audit findings with clear references for non-clinicians
• Create reports and reference guides for team communication
• Assist in training new team members and improving team processes