Associate, Payment Integrity IBRActive$83K–$109K
The opportunity
Hi, we're Oscar. We're hiring an Associate, Itemized Bill Review to join our Payment Integrity team.
What you'll do
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
What they're looking for
- 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
