Senior Analyst, Payment Integrity

📋 Description

• Act as a subject matter expert for Oscar reimbursement policies and claim edits.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research coding rules; summarize and input into reimbursement policy language.
• Translate research and claims insights into business requirements; collaborate to enable change.
• Ingest adverse claim data from partners; scope, size, and prioritize improvements.
• Based in NYC with a hybrid schedule; 3 in-office days per week, Thursdays required.

🎯 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).
• 2+ years experience deriving business insights from datasets and solving problems.
• 1+ years experience improving business workflows and processes.

🎁 Benefits

• Medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance