Description

You will support payment integrity disputes and issue resolution in the Oscar claim environment. You will scope, triage, investigate, and execute on solutions and process improvements, leveraging deep knowledge of claim infrastructure and workflows to translate stakeholder friction into actionable improvements.

Requirements

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

Responsibilities

• Contribute as subject matter expert for reimbursement policies and payment integrity disputes
• Respond to inquiries and disputes regarding policies and edits
• Research coding rules and provide input into reimbursement policy language
• Translate payment integrity opportunities into business requirements and collaborate on implementation
• Ingest partner input on adverse claim outcomes and collaborate to scope and deliver solutions