Humana
Medicaid Provider Hospital Reimbursement Methodologies Analyst
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Job Description
- Req#: R-392574
Employer Industry: Healthcare Insurance Services
Why consider this job opportunity:
- Salary up to $121,400 per year
- Eligible for a bonus incentive plan based on company and individual performance
- Comprehensive benefits package including medical, dental, vision, and 401(k) retirement savings plan
- Generous time off policies including paid time off, volunteer time off, and paid parental leave
- Opportunity to work remotely from anywhere in the United States
- Supportive and inclusive workplace culture focused on employee well-being
What to Expect (Job Responsibilities):
- Administer and maintain Medicaid provider reimbursement methodologies for hospitals and facilities
- Research state-specific Medicaid reimbursement requirements and methodologies
- Develop and maintain expertise in complex grouping concepts utilized in Medicaid reimbursement
- Collaborate with IT and pricing software vendors to implement system changes and resolve issues
- Create and execute comprehensive test plans for new Medicaid pricers and ongoing maintenance
What is Required (Qualifications):
- 3+ years of experience researching state Medicaid hospital reimbursement methodologies (e.g., MS-DRG, APR-DRG, APC, EAPG)
- 2+ years of experience with Optum Rate Manager and Optum WebStrat or PSI applications
- Experience in reviewing facility claims
- Proficiency in Microsoft Excel for basic data analysis and use of pivot tables and functions (e.g., VLOOKUP)
- Ability to work from a dedicated space that protects member PHI / HIPAA information
How to Stand Out (Preferred Qualifications):
- Experience in researching and resolving provider reimbursement inquiries
- Familiarity with MS-DRG, APR-DRG, and/or EAPG grouper logic
- Experience interacting with State Medicaid or Federal government agencies
- Intermediate skills in Microsoft Access
#HealthcareInsurance #RemoteWork #CareerOpportunity #CompetitivePay #EmployeeBenefits
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