Oscar Health · 4 weeks ago
Associate, Payment Integrity, IBR
Tempe, Arizona, United States
Full-time
Hybrid
Entry Level
$80K/yr - $105K/yr
4+ years expOscar is a health insurance company focused on leveraging technology to serve its members. The Associate, Payment Integrity, Itemized Bill Review will be responsible for executing payment integrity solutions, ensuring accurate and timely claims processing by reviewing billing and coding practices.
Health CareHealth InsuranceInsuranceInsurTech
Responsibilities
Perform line-by-line review of high-dollar facility itemized bills and corresponding claim forms (e.g., UB-04s)
Proactively identify and document potential billing errors, including duplicate billing of items, services, or procedures as improper unbundling of services (e.g., separating components that should be billed together) and charges for non-covered or non-rendered services
Compare billed charges against both payor-specific contracts and industry guidelines to confirm appropriate billing practices
Apply working knowledge of national coding systems (e.g., CPT, HCPCS, ICD-10, MS-DRGs) to validate the accuracy of codes used for services billed
Review claims eligible under specific reimbursement scenarios: a percentage of charges or those exceeding stop-loss levels, ensuring the claim exceeds the minimum dollar threshold set by the payor
Prepare clear, concise, and professional documentation of all findings, including savings identified, policy violations, and recommended claim adjustments
Contribute to the refinement of internal audit processes and tools to enhance efficiency and accuracy in identifying claim inaccuracies
Serve as a subject matter expert for internal and external stakeholders regarding complex billing issues, coding guidelines, and payor policies
Provide subject matter expertise and in-depth understanding of Payment Integrity internal claims processing edits, external vendor edits and Oscar reimbursement policies
Identify claims payment issues from data mining, process monitoring, etc., provide scoping and action steps needed to remediate the issue
Respond to internal and external inquiries and disputes regarding policies and edits
Document industry standard coding rules and provide recommendations on reimbursement policy language and scope
Ideate payment integrity opportunities based on a deep knowledge of industry standard coding rules. Translate into business requirements; submit to and collaborate with internal partners to effectuate change
Provide training and education to team members when necessary
Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate
Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership
Compliance with all applicable laws and regulations
Other duties as assigned
Qualification
Required
A bachelor's degree or 4+ years of commensurate experience
2+ years of bill / coding audit experience with a focus on hospital or facility billing (UB-04)
4+ years 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
Preferred
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
Benefits
Employee benefits
Participation in Oscar's 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
Company
Oscar Health
Oscar is a health insurance company that offers individual and family plans, medicare advantages, and small group products.
1001-5000 employees
H1B Sponsorship
Oscar Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (19)
2024 (24)
2023 (22)
2022 (36)
2021 (13)
Funding
Current Stage
Public CompanyTotal Funding
$1.99BKey Investors
Tiger Global ManagementAlphabetFounders Fund
2025-09-16Post Ipo Debt· $355M
2021-03-03IPO
2020-12-17Private Equity· $140M
Leadership Team
Mark Bertolini
Chief Executive Officer
Steven B. Kelmar
Executive Vice President & COS
Recent News
Sherwood News
2026-01-09
Investor's Business Daily
2025-12-18
Company data provided by crunchbase