Tech Stack

Description

You will support process improvement and issue resolution in Oscar's claim environment by leveraging knowledge of claim infrastructure, workflows, and data models to identify and execute on payment integrity opportunities. You will work cross-functionally with stakeholders, research reimbursement policies, and collaborate on solutions.

Requirements

• Bachelor's degree or 4+ years commensurate experience
• 3+ years in claims processing, coding, auditing, or healthcare claims operations
• 3+ years medical coding experience within payment integrity
• Medical coding certification (CPC, COC, CCS, RHIT, RHIA)
• Experience with reimbursement methodologies and claims processing practices

Responsibilities

• Contribute as subject matter expert for reimbursement policies and payment integrity edits
• Respond to inquiries and disputes regarding policies and edits
• Research coding rules and provide input into reimbursement policy
• Ideate payment integrity opportunities and translate into business requirements
• Collaborate with partners to scope, prioritize, and deliver solutions