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sql process improvement six sigma data mining medical coding📋 Description
- Support payment integrity disputes and resolution in Oscar claim environment.
- Scope, triage, investigate, and implement solutions leveraging claim data.
- Work cross-functionally to translate stakeholder friction into improvements.
- Report to Manager, Payment Integrity; keep stakeholders informed.
- Remote role; open to listed US metro areas; may become hybrid.
- Ensure compliance with applicable laws and regulations.
🎯 Requirements
- Experience in Payment Integrity focusing on disputes/appeals.
- 4+ years in claims processing, coding, auditing or health care operations.
- 3+ years experience in medical coding.
- AAPC CPC/COC or AHIMA CCS/RHIT/RHIA certification.
- Experience with reimbursement methodologies, provider contracts, and claims processing.
- 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; life and disability insurance.
- Unlimited vacation program and annual performance bonuses.
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