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 Sr. Manager, Payment Integrity. Work Location: This position is based in our Tempe, Arizona office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid 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 3+ years of experience in claims processing, coding, auditing or health care claims 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 using SQL This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here . At Oscar, being an Equal Opportun ... (truncated, view full listing at source)