Description

You will manage and execute payment policy activities, including resolving claims payment issues, analyzing data to identify policy remediation steps, and ensuring alignment with industry standards. Collaborate with internal teams to update payment policies and support Oscar's mission to revolutionize health insurance.

Requirements

• Bachelor's degree or 4+ years commensurate experience.
• 4+ years experience in claims processing, coding, auditing, or healthcare operations.
• Medical coding certification (CPC, COC, CCS, RHIT, RHIA).
• Experience with reimbursement methodologies and provider contract concepts.
• Ability to work independently and drive projects to completion.

Responsibilities

• Provide expertise on Payment Integrity claims processing edits, vendor edits, and reimbursement policies.
• Analyze data to identify claims payment issues and define remediation steps.
• Ensure claims align with industry best practices, internal policies, and regulations.
• Respond to internal and external inquiries regarding policies and edits.
• Document coding rules and draft recommendations on reimbursement policy language.