Medicaid (PPS) Provider Hospital Reimbursement Methodologies Anal...
Humana Inc - Billings Metropolitan Area, Montana, United States,Work at Humana Inc
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Overview
Medicaid (PPS) Provider Hospital Reimbursement Methodologies Analyst
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locations
Remote Nationwide
time type
Full time
posted on
Posted Yesterday
job requisition id
R-336900
Become a part of our caring community and help us put health firstThe Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral part of the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new states. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities.
Responsibilities:
The Senior Business Intelligence Engineer will be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities. They will work closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid business at Humana. The Senior Business Intelligence Engineer will develop and maintain expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, APR-DRG, MS-DRG, etc). This role is within the Integrated Network Payment Solutions (INPS) department which falls under the Provider Process and Network Organization (PPNO).The Senior Business Intelligence Engineer will be responsible for:Researching state-specific Medicaid reimbursement methodologies for hospitals and facilitiesDeveloping expertise in complex groupers (EAPG, APR-DRG, MS-DRG, etc) utilized in Medicaid reimbursementReviewing Medicaid RFPs and state contracts to identify provider reimbursement requirementsSupporting implementation of new Medicaid pricers including:
Reviewing pricing software vendor specifications;Identifying system changes needed to accommodate state-specific logic;Assisting with requirements development; andCreating and executing comprehensive test plans
Ongoing Medicaid pricer maintenance, quality assurance, and complianceDetermining root causes driving issues and developing solutionsWorking closely with IT and pricing software vendor to resolve issuesDeveloping Policies & ProceduresIdentifying automation and improvement opportunitiesResearching and resolving provider reimbursement inquiries
Use your skills to make an impactRequired Qualifications3+ years of experience researching state Medicaid hospital reimbursement methodologies that utilize MS-DRG, APR-DRG, APC or EAPG2+ years of experience researching MS-DRG, APR-DRG and/or EAPG grouper logicExperience processing or reviewing facility claimsPrior professional experience utilizing Microsoft Excel (e.g. performing basic data analysis in excel and utilizing pivot tables and various functions such as VLOOKUP)Meet Humana's WAH policy listed in additional informationPreferred QualificationsExperience researching and resolving provider reimbursement inquiriesExperience with Optum Rate ManagerExperience with Optum WebStrat or PSI applicationsExperience interacting with a State Medicaid or Federal government agencyIntermediate Microsoft Access skillsAdditional InformationLocation: Remote United StatesAs part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your scheduleTo ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipEmployees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA informationScheduled Weekly Hours40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$78,800 - $108,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About usHumana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.Similar Jobs (1)
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