Associate, Payment Policy

Hi, we're Oscar. We're hiring a Payment Policy Associate to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

The Payment Policy Associate manages and executes all payment policy activities, including organizing, scoping, investigating, and resolving payment policy issues. Responsibilities also involve delegating and prioritizing project tasks effectively. This work relies on internal team research and a thorough understanding of Oscar's claim infrastructure to draft and update payment policies accurately.

You will report to the Manager, Payment Policy

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $88,800 - $116,550 per year. The base pay for this role in all other locations is: $79,920 - $104,895 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Provide subject matter expertise and in-depth understanding of 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—both industry-wide and Oscar-specific.
• 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 into business requirements; submit to 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, 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

Qualifications

• 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 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.

Bonus Points

• 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