Coding Specialist – Payment Integrity
| Company | Oscar Health |
|---|---|
| Location | California, USA, Arizona, USA, New York, NY, USA |
| Salary | $67230 – $91300 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level, Senior |
Requirements
- A bachelor’s degree or 4+ years of commensurate experience
- 3+ years of experience in claims processing, coding, auditing or health care operations
- 3+ years experience in medical coding
- Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
- Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices
- 2+ years experience deriving business insights from datasets and solving problems
Responsibilities
- Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.
- Respond to internal and external inquiries and disputes regarding policies and edits.
- Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
- Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
- Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
- Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
- Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
- Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
Preferred Qualifications
- 2+ years experience in a technical role (QA analyst, PM, operations analyst, finance, consulting, industrial engineering) or a process improvement role (Six Sigma or similar)
- 2+ years of experience working with large data sets using excel or a database language
- Experience in a professional healthcare claims organization
- Knowledge management, training, or content development in operational settings
- Process Improvement or Lean Six Sigma training
- Experience using SQL