Tech Stack

Description

You will support payment integrity disputes and issue resolution in the Oscar claim environment, leveraging deep understanding of claim infrastructure to scope, triage, investigate, and execute solutions and process improvements. Collaborate cross-functionally to translate stakeholder friction into actionable opportunities.

Requirements

• Experience in Payment Integrity focused on disputes and/or appeals
• 4+ years in claims processing, coding, auditing, or healthcare operations
• 3+ years experience in medical coding
• Medical coding certification (CPC, COC, CCS, RHIT, RHIA)
• 2+ years experience deriving business insights from datasets and solving problems

Responsibilities

• Serve as subject matter expert for reimbursement policies and payment integrity disputes
• Research industry coding rules and provide input into reimbursement policy language
• Translate payment integrity opportunities into business requirements and collaborate with internal partners
• Analyze adverse claim outcomes and collaborate to scope, size, prioritize, and deliver solutions
• Proactively identify thematic areas for improvement using data mining and process monitoring