Senior Analyst, Payment Integrity Disputes

Responsibilities

• Act as a subject matter expert for reimbursement policies, payment integrity disputes, and claims processing edits
• Respond to internal and external inquiries and disputes regarding policies and edits
• Research industry standard coding rules and provide input into reimbursement policy language
• Translate payment integrity opportunities into business requirements and collaborate with internal partners
• Ingest information from partners regarding adverse claim outcomes to scope and deliver solutions
• Proactively identify thematic areas of opportunity through data mining and process monitoring
• Support state objectives by providing research, root cause analysis, and training

Requirements

• Experience in Payment Integrity focused on Disputes and/or appeals
• 4+ years of experience in claims processing, coding, auditing, or healthcare operations
• 3+ years of experience in medical coding
• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
• Experience with reimbursement methodologies and provider contract concepts
• 2+ years experience deriving business insights from datasets
• 1+ years experience improving business workflows and processes
• 1+ years experience collaborating with internal and external stakeholders

Preferred Qualifications

• 2+ years in a technical or process improvement role (Six Sigma, QA, PM, or Operations Analyst)
• 2+ years experience working with large datasets using Excel or database languages
• Experience in a professional healthcare claims organization
• Knowledge management, training, or content development experience
• Experience using SQL

About the Company

Oscar is a health insurance company built around a full stack technology platform and a relentless focus on serving members, aiming to behave like a doctor in the family.