Coding Specialist, Payment Integrity

This role is responsible for supporting process improvement and dispute resolution in the Oscar payment integrity environment. The Specialist reviews, investigates, and resolves provider disputes related to claims, payments, contract terms, etc. This is accomplished by leveraging a deep understanding of Oscar’s claim and payment integrity infrastructure. You will contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits. You will respond to internal and external inquiries and disputes regarding policies and edits. You will also research industry standard coding rules, summarize and provide input into reimbursement policy language and scope. The role requires using knowledge gained through research and claims review to ideate payment integrity opportunities and translating them into business requirements. The role also entails supporting Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership. The role also requires compliance with all applicable laws and regulations and other duties as assigned.