Senior Analyst, Payment Integrity

📋 Description

• Contribute as SME for Oscar reimbursement policies and edits.
• Respond to inquiries and disputes about policies and edits.
• Research industry coding rules; summarize policy scope.
• Translate research into business requirements; collaborate to implement changes.
• Ingest information from partners to scope, size, prioritize items, and deliver solutions.
• Use data insights and process monitoring to identify opportunities.

🎯 Requirements

• Bachelor's degree or 4+ years of related experience.
• 3+ years in claims processing, coding, auditing or health care claims ops.
• 3+ years medical coding within payment integrity.
• AAPC CPC/COC or AHIMA CCS/RHIT/RHIA certification.
• Experience with reimbursement methodologies and provider contracts.
• 2+ years deriving business insights from datasets.

🎁 Benefits

• Medical, dental, and vision benefits.
• 11 paid holidays.
• Paid sick time.
• Paid parental leave.
• 401(k) plan participation.
• Unlimited vacation program.