Senior Analyst, Payment Integrity

<p>Hi, we're Oscar. We're hiring a Senior Analyst to join our Payment Integrity team.</p> <p>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.</p> <p><strong>About the role:</strong></p> <p>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. </p> <p>You will report into the Sr. Manager, Payment Integrity.</p> <p><strong>Work Location: </strong>This position is based in our New York City 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</p> <p><strong>Pay Transparency: </strong>The base pay for this role is: $72,036 - $94,547 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.</p> <p><strong>Responsibilities:</strong></p> <ul> <li>Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.</li> <li>Respond to internal and external inquiries and disputes regarding policies and edits.</li> <li>Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.</li> <li>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.</li> <li>Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.</li> <li>Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.</li> <li>Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate. </li> <li>Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership. </li> <li>Compliance with all applicable laws and regulations</li> <li>Other duties as assigned</li> </ul> <p><strong>Requirements:</strong></p> <ul> <li>A bachelor’s degree or 4+ years of commensurate experience </li> <li><em>3+ years of experience in claims processing, coding, auditing or health care claims operations</em></li> <li>3+ years experience in medical coding within payment integrity </li> <li>Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)</li> <li>Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.</li> <li>2+ years experience deriving business insights from datasets and solving problems </li> <li>1+ years experience improving business workflows and processes</li> <li>1+ years experience collaborating with internal and/or external stakeholders</li> </ul> <p><strong>Bonus points:</strong></p> <ul> <li>2+ years experience in a technical role (QA analyst, PM, opera ... (truncated, view full listing at source)