Medicaid Hospital Reimbursement Analyst

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $60.8k - $82.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

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

• Build and maintain working knowledge of Medicaid reimbursement methodologies and complex grouping concepts, including EAPG, APR-DRG, and MS-DRG • Research state-specific Medicaid reimbursement methodologies for hospitals and facilities • Develop expertise in complex groupers used in Medicaid reimbursement • Monitor state Medicaid and Solventum websites for provider reimbursement changes • Analyze updates for impacts to Medicaid pricer reimbursement • Review software vendor release notes • Develop and execute test plans for Medicaid pricer updates • Partner with IT and the pricing software vendor to resolve issues • Research and resolve provider reimbursement inquiries • Identify inquiry patterns and translate insights into process improvement and automation opportunities • Perform root cause analysis and escalate complex issues to senior team members or leadership as appropriate

🎯 Requirements

• Minimum 2 years of experience researching state Medicaid hospital reimbursement methodologies utilizing EAPG, APR-DRG, or MS-DRG • Experience reviewing facility claims • Experience researching and resolving provider reimbursement inquiries • Experience testing system updates or enhancements • Prior professional experience using Microsoft Excel, including basic data analysis, pivot tables, formulas, and functions • Ability to meet work-from-home internet requirements: at least 25 Mbps download and 10 Mbps upload • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Personal wellness and smart healthcare decision support • Dedicated work-from-home space and internet requirements to support remote work