Senior Hospital Reimbursement Analyst

🔥 18 minutes ago

🐎 Kentucky, North Carolina, +3 more states – Remote

🐎 Kentucky – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote

💵 $80.9k - $110.3k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Researching and maintaining expertise in Medicare Outpatient Prospective Payment System reimbursement methodologies (OPPS, ASC, FQHC, etc.) • Demonstrating expertise in Medicare Integrated Outpatient Code Editor (I/OCE) logic (i.e. grouping rules, OCE data files, editing, etc.) • Analyzing and interpreting CMS Regulatory documentation for Medicare Prospective Payment Systems (i.e. final and proposed rules, transmittals, manuals, legislation, etc.) • Supporting implementation of Medicare pricer projects and enhancements • Reviewing pricing software vendor specifications; Identifying system changes needed to accommodate CMS logic; Assisting with requirements development; Creating and executing comprehensive test plans • Ongoing Medicare pricer maintenance, quality assurance, and compliance • Determine root causes driving issues and developing solutions • Working closely with IT and pricing software vendor to resolve issues • Utilize data and expertise to identify automation and improvement opportunities • Research and resolve complex provider reimbursement inquiries and advise operational teams on pricer edit resolution • Provide consultation to internal business partners on Medicare reimbursement/editing logic and Humana system logic

🎯 Requirements

• Minimum 3 years of experience researching Medicare Prospective Payment System (PPS) reimbursement methodologies for hospitals • Minimum 3 years of experience reviewing facility claims • Minimum 2 years of experience with Optum Rate Manager • Strong oral and written communication skills

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance • many other opportunities