Itemized Bill Reviewer

Oscar Health

. Execute internal payment integrity solutions requiring billing and coding expertise .

Posted 10/22/2026full-timeRemote • United StatesMid-LevelSenior💰 $82,717 - $108,566 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in billing and coding, with a strong focus on payment integrity solutions and compliance with industry guidelines. Proficient in analyzing claims, identifying errors, and developing remediation strategies while collaborating with stakeholders.

Highest-signal resume keywords

Medical Coding Certification (CPC, COC, CCS, RHIT, RHIA)Bill/Coding Audit Experience (UB-04)Reimbursement MethodologiesData Analysis Using Excel or SQLProcess Improvement (Lean Six Sigma)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Billing ExpertiseCoding ExpertiseData MiningClaim ReviewError IdentificationPolicy DocumentationAudit Process RefinementService Code ValidationRoot Cause AnalysisBusiness Requirement Development

Soft Skills

Training and EducationStakeholder CommunicationProblem SolvingCollaborationResearch

Certifications & Qualifications

AAPC CertificationAHIMA Certification

Industry Keywords

Payment IntegrityFacility BillingClaims ProcessingProvider Contract ConceptsComplianceOperational Settings

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Execute internal payment integrity solutions requiring billing and coding expertise
Review high-dollar facility itemized bills and corresponding claim forms line by line
Identify and document billing errors, duplicate billing, improper unbundling, and charges for non-covered or non-rendered services
Compare billed charges against payor-specific contracts and industry guidelines
Apply national coding systems to validate service codes
Review claims under specific reimbursement scenarios and stop-loss thresholds
Document findings, savings, policy violations, and recommended claim adjustments
Refine internal audit processes and tools
Serve as a subject matter expert on billing issues, coding guidelines, and payor policies
Identify payment issues through data mining and process monitoring, and define remediation actions
Respond to policy and edit inquiries and disputes
Document coding rules and recommend reimbursement policy language and scope
Develop payment integrity opportunities into business requirements and collaborate with internal partners
Train and educate team members
Keep stakeholders informed of progress, blockers, and status changes
Support escalated issues through research and root cause analysis
Comply with applicable laws and regulations
Perform other duties as assigned

Requirements

What you’ll need

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
Bonus: 3+ years of experience working with large data sets using Excel or a database language
Bonus: Knowledge management, training, or content development in operational settings
Bonus: Process Improvement or Lean Six Sigma training
Bonus: Experience using SQL

Benefits

Comp & perks

Employee benefits
Unlimited vacation program
Annual performance bonuses
Medical benefits
Dental benefits
Vision benefits
11 paid holidays
Paid sick time
Paid parental leave
401(k) plan participation
Life insurance
Disability insurance
Paid wellness time and reimbursements
Occasional travel for team meetings and company events