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Salary: USD 91,908 - 120,629 / annual
Oscar Health is seeking an Associate, Payment Integrity - Itemized Bill Review (IBR) to join the Payment Integrity team in New York. This role focuses on executing internal payment integrity solutions with expertise in medical billing and coding, ensuring claims are paid accurately and timely.
Key responsibilities include performing line-by-line reviews of high-dollar facility itemized bills and corresponding claim forms (UB-04s), proactively identifying billing errors such as duplicate billing, improper unbundling, and charges for non-covered services. You will compare billed charges against payor-specific contracts and industry guidelines, apply knowledge of national coding systems (CPT, HCPCS, ICD-10, MS-DRGs) to validate billing accuracy, and review claims under specific reimbursement scenarios.
You will prepare detailed documentation of findings including identified savings, policy violations, and recommended claim adjustments. The role involves contributing to refinement of internal audit processes and tools, serving as a subject matter expert for internal and external stakeholders on complex billing issues and coding guidelines, and identifying claims payment issues through data mining and process monitoring.
Additional responsibilities include responding to internal and external inquiries regarding policies and edits, documenting industry standard coding rules, ideating payment integrity opportunities, providing training to team members, and supporting Oscar's operational objectives through research and root cause analysis.
The position reports to the Manager, Payment Integrity (Pre-Pay) and requires a hybrid work schedule with 3 days in-office per week, with Thursdays as a mandatory in-office day.
