Tech Stack

Description

You will support payment integrity disputes and issue resolution, leveraging your deep understanding of Oscar's claim infrastructure to scope, triage, investigate, and execute solutions. You'll work cross-functionally to translate stakeholder friction into actionable improvements.

Requirements

• 4+ years in claims processing, coding, auditing or healthcare operations
• 3+ years experience in medical coding
• Medical coding certification (CPC, COC, CCS, RHIT, RHIA)
• Experience with reimbursement methodologies and claims resolution
• 2+ years deriving business insights from datasets

Responsibilities

• Act as subject matter expert for reimbursement policies and payment integrity disputes
• Respond to and research inquiries regarding policies and edits
• Research industry coding rules and summarize for policy language
• Identify payment integrity opportunities and translate into business requirements
• Collaborate with partners to scope and prioritize solutions