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Medicaid Provider Hospital Reimbursement Methodologies Analyst
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Job Description
- Req#: R-392574
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $121,400 per year
- Eligible for a bonus incentive plan based on company and/or individual performance
- Competitive benefits including medical, dental, vision, 401(k), paid time off, and more
- Opportunity for career advancement and growth within the organization
- Flexible remote work arrangement
- Work with a supportive team dedicated to improving healthcare delivery
What to Expect (Job Responsibilities):
- Research state-specific Medicaid reimbursement methodologies for hospitals and facilities
- Develop expertise in complex groupers (EAPG, APR-DRG, MS-DRG, etc.) utilized in Medicaid reimbursement
- Review Medicaid RFPs and state contracts to identify provider reimbursement requirements
- Support implementation of new Medicaid pricers, including system changes and comprehensive test plans
- Research and resolve provider reimbursement inquiries
What is Required (Qualifications):
- 3+ years of experience researching state Medicaid hospital reimbursement methodologies that utilize MS-DRG, APR-DRG, APC, or EAPG
- 2+ years of experience with Optum Rate Manager
- 2+ years of experience with Optum WebStrat or PSI applications
- Experience reviewing facility claims
- Proficient in Microsoft Excel, including data analysis and use of pivot tables or functions like VLOOKUP
How to Stand Out (Preferred Qualifications):
- Experience researching and resolving provider reimbursement inquiries
- Familiarity with MS-DRG, APR-DRG, and/or EAPG grouper logic
- Interaction experience with a State Medicaid or Federal government agency
- Intermediate skills in Microsoft Access
#HealthcareServices #Medicaid #RemoteWork #CareerOpportunity #CompetitiveBenefits
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