oscar health insuranceBrooklyn, NY
Itemized Bill Reviewer
Itemized Bill Reviewer
Itemized Bill Reviewer
oscar health insuranceBrooklyn, NY
7 days ago
Health Information Technologists and Medical RegistrarsBilling and Posting ClerksMedical Records Specialists
Apply for this role (opens in a new tab)Overview:
In this role you'll drive accurate and timely payment of claims through expert review of high-dollar facility bills and robust coding application. You'll work with Oscar's claim infrastructure and cross-functional teams to translate stakeholder friction into actionable improvements. You'll act as a subject-matter expert on billing and payor policies, shaping processes and tools to raise efficiency and accuracy. This position offers the opportunity to impact reimbursement practices and enhance overall payment integrity within a collaborative, data-driven environment. You'll join a hybrid NYC team with meaningful mission to improve health care experiences for our members. Compensation / Benefitsmedical, dental, and vision benefits11 paid holidayspaid sick timepaid parental leave 401(k) plan participationlife and disability insurance? (listed as benefits)
Responsibilities:
- Perform line-by-line review of high-dollar facility itemized bills and related claim forms (e.g., UB-04)
- Identify and document potential billing errors such as duplicate billing, improper unbundling, and charges for non-covered/non-rendered services
- Compare billed charges to payor contracts and industry guidelines to validate practices
- Apply knowledge of CPT, HCPCS, ICD-10, MS-DRGs to verify code accuracy
- Review eligibility under specific reimbursement scenarios (percentage of charges or stop-loss thresholds) and ensure minimum thresholds are met
- Document findings clearly, including savings, policy violations, and recommended claim adjustments
- Contribute to refining internal audit processes and tools for efficiency and accuracy
- Serve as SME for complex billing issues to internal and external stakeholders
- Provide SME-level understanding of internal claims edits, external vendor edits and Oscar policies
- Identify payment issues from data mining and monitoring, outline remediation steps
- Respond to inquiries and disputes regarding policies and edits
- Document industry coding rules and recommend policy language and scope
- Ideate payment integrity opportunities and translate into business requirements for cross-functional execution
- Provide training to team members as needed
- Maintain transparency with stakeholders and escalate blockers as needed
- Support state objectives with rapid research, root cause analysis, and training when escalated
- Comply with applicable laws and regulations
- Other duties as assigned
Key requirements:
- Bachelor's degree or 4+ years of commensurate experience 2+ years of bill/coding audit experience with hospital/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 contracts, and common claims processing practicesstrong communication and documentationcross-functional collaborationtrainability and knowledge sharingCPTHCPCSICD-10
Also on the board Same function, level within a rung
Level
Senior
Location
Brooklyn, NY
Occupation
Health Information Technologists and Medical Registrars
Industry
General Medical and Surgical Hospitals
Posted
7 days ago