Senior Analyst, Payment Integrity

Hi, we're Oscar . We're hiring a Senior Analyst to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role:

This role is responsible for supporting process improvement and issue resolution in the Oscar claim environment for both the Oscar Insurance business and + Oscar clients. The Senior Analyst, Payment Integrity role organizes, scopes, prepares , investigates and/or executes on solutions and process improvements within edits and ideation. This is accomplished by leveraging a deep understanding of Oscar ’s claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement.

You will report into the Senior Manager, Payment Integrity.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area.

Pay Transparency: The base pay for this role is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar 's unlimited vacation program and annual performance bonuses.
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.

- Compliance with all applicable laws and regulations

- Other duties as assigned

Requirements:

- A bachelor’s degree or 4+ years of commensurate experience

- 4+ years of experience in claims processing, coding, auditing or health care operations

- 3+ years experience in medical coding within payment integrity

- 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

- 1+ years experience improving business workflows and processes

- 1+ years experience collaborating with internal and/or external stakeholders

Bonus points:

- 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)

- Process Improvement or Lean Six Sigma training

- Experience usin