Humana
Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst
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Job Description
- Req#: R-389951
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 including medical, dental, vision, and 401(k) retirement savings plan
- Generous paid time off, including volunteer time off and paid parental leave
- Opportunity for career advancement and growth within the organization
- Work remotely with occasional travel to the employer's offices for training or meetings
What to Expect (Job Responsibilities):
- Research and maintain expertise in Medicare Outpatient Prospective Payment System reimbursement methodologies
- Analyze and interpret CMS Regulatory documentation for Medicare Prospective Payment Systems
- Support implementation of Medicare pricer projects and enhancements including reviewing vendor specifications
- Conduct ongoing Medicare Pricer maintenance, quality assurance, and compliance
- Provide consultation to internal business partners on Medicare reimbursement/editing logic
What is Required (Qualifications):
- Strong understanding of Medicare reimbursement methodologies
- Minimum of 3 years of experience in healthcare reimbursement or related field
- Proficient in analyzing regulatory documentation and pricing software
- Exceptional problem-solving skills to determine root causes and develop solutions
- Ability to work independently in a home office environment with required internet speed
How to Stand Out (Preferred Qualifications):
- Experience working with Integrated Outpatient Code Editor (I/OCE) logic
- Familiarity with data automation and improvement opportunities
- Prior experience in a remote work setting
- Knowledge of HIPAA regulations and compliance
- Excellent communication skills for collaboration with cross-functional teams
#HealthcareInsurance #RemoteWork #CareerGrowth #CompetitiveBenefits #MedicareReimbursement
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