Medicaid Provider - Hospital Reimbursement Methodologies Analyst

February 25

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Humana

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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.

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

📋 Description

• Part of the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. • Support existing Medicaid business and expansion into new states. • Work closely with IT, pricing software vendor, Medicaid operations, claims operations, and other business teams. • Develop and maintain expertise in Medicaid reimbursement methodologies. • Research state-specific Medicaid reimbursement methodologies. • Review Medicaid RFPs and state contracts. • Support implementation of new Medicaid pricers. • Ensure ongoing Medicaid pricer maintenance, quality assurance, and compliance.

🎯 Requirements

• 3+ years of experience researching state Medicaid hospital reimbursement methodologies that utilize MS-DRG, APR-DRG, APC or EAPG • 2+ years of experience researching MS-DRG, APR-DRG and/or EAPG grouper logic • Experience processing or reviewing facility claims • Prior professional experience utilizing Microsoft Excel; performing basic data analysis in excel and utilizing pivot tables and various functions such as VLOOKUP

🏖️ Benefits

• Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Volunteer time off • Paid parental leave • Caregiver leave • Short-term disability • Long-term disability • Life insurance • Opportunities for additional support