Oscar is looking for an Associate, Payment Policy to manage and execute all payment policy activities, including organizing, scoping, investigating, and resolving payment policy issues. This work relies on internal team research and a thorough understanding of Oscar's claim infrastructure to draft and update payment policies accurately.

What You'll Do

Provide subject matter expertise on Payment Integrity internal claims processing edits, external vendor edits, and Oscar reimbursement policies.
Analyze data mining and process monitoring to pinpoint claims payment issues, then define the scope and steps for policy remediation.
Examine industry standards to confirm claim payments align with industry best practices, internal policies, and regulations.
Respond to internal and external inquiries and disputes regarding policies and edits.
Document industry standard coding rules and draft recommendations on reimbursement policy language and scope.
Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules, translate them into business requirements, and collaborate with internal partners to effectuate change.
Attend regulation update meetings and relay information to team members, providing training and education as needed.
Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, and completion.
Support Oscar run state objectives by providing speedy research, root cause analysis, and training whenever issues are escalated and assigned by leadership.
Ensure compliance with all applicable laws and regulations.

What We're Looking For

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 of experience in medical coding.
Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA).
Experience with reimbursement methodologies, provider contract concepts, and common claims processing/resolution practices.
3+ year(s) ability to work independently to drive projects to completion.

Nice to Have

3+ years of experience working with large data sets using Excel or a database language.
Knowledge management, training, or content development in operational settings.
Process Improvement or Lean Six Sigma training.
Experience using SQL.

Team & Environment

You will report into the Manager, Payment Policy.

Benefits & Compensation

Employee benefits.
Unlimited vacation program.
Annual performance bonuses.
Medical, dental, and vision benefits.
11 paid holidays.
Paid sick time.
Paid parental leave.
401(k) plan participation.
Life and disability insurance.
Paid wellness time and reimbursements.
Compensation: $79,920 - $104,895 per year.

Work Mode

This is a remote position open to candidates in Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; and Salt Lake City, Utah.

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.