Associate, Payment Integrity at Oscar Health

, , -

Full Time

Start Date

Immediate

Expiry Date

02 Jan, 26

Salary

104895.0

Posted On

04 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Processing, Coding, Auditing, Health Care Operations, Payment Integrity, Reimbursement Methodologies, Provider Contract Concepts, Claims Resolution, Data Analysis, SQL, Industry Standard Coding Rules, Coordination of Benefits, Thought Leadership, Training, Research, Root Cause Analysis

Industry

Insurance

Description

Hi, we're Oscar. We're hiring a Coordination of Benefits Associate to join our Payment Integrity team. Oscar is the first health insurance company built around a full stack technology platform and a 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 The Associate, Payment Integrity is responsible for leading Coordination of Benefits efforts within the claims and Payment Integrity space. This is accomplished by leveraging a deep understanding of Oscar's claim infrastructure, workflows, workflow tooling, platform logic, data models, etc. The Associate provides thought leadership for Payment Integrity Coordination of Benefits processes and workflows. The Associate leverages industry-standard knowledge and proven practices in Coordination of Benefits (COB) auditing to identify overpayments, prevent inaccurate claim adjudication, and support overall payment integrity. You will report to the Senior Manager, Payment Integrity Work Location: This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, or Texas. #LI-Remote Pay Transparency: The base pay for this role is: $79,920 - $104,895 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities Provide subject matter expertise and in-depth understanding of Payment Integrity internal claims processing edits, external vendor edits and Oscar reimbursement policies. Lead Coordination of Benefits efforts within the payment integrity department. Respond to internal and external inquiries and disputes regarding COB policies and workflows Document industry standard coding rules and provide recommendations on reimbursement policy language and scope. Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules and coordination of benefits. Provide training and education to team members when necessary. 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 Qualifications A bachelor's degree or 4+ years of commensurate experience 4+ years of experience in claims processing, coding, auditing or health care operations 4+ years experience in Payment Integrity Experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices. Bonus points 3+ years of experience working with large data sets using excel or a database language 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 Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.

Responsibilities

The Associate is responsible for leading Coordination of Benefits efforts within the claims and Payment Integrity space. This includes providing thought leadership for Payment Integrity processes and workflows, identifying overpayments, and supporting overall payment integrity.