Medicaid Provider Hospital Reimbursement Methodologies Analyst

Freddie Mac; United States; Remote; USD 89,000 - 122,000; Full time

Job summary

Join a leading healthcare company as a Medicaid Provider Hospital Reimbursement Analyst. This remote role involves supporting Medicaid operations, implementing reimbursement methodologies, and collaborating with various teams. Ideal candidates have experience in Medicaid reimbursement and strong analytical skills. Enjoy a competitive salary, comprehensive benefits, and opportunities for professional growth.

Benefits

Comprehensive benefits supporting health, wellness, and financial security

Qualifications

• 3+ years researching Medicaid hospital reimbursement methodologies.
• 2+ years understanding MS-DRG, APR-DRG, and/or EAPG grouper logic.

Responsibilities

• Implement and support Medicaid provider reimbursement for hospitals.
• Collaborate with IT and vendor partners in Medicaid administration.
• Analyze root causes of issues and develop solutions.

Skills

Researching Medicaid hospital reimbursement methodologies

Understanding MS-DRG

Data analysis

Tools

Microsoft Excel

Microsoft Access

Job description

Become a part of our caring community and help us put health first

The Medicaid (PPS) Provider Hospital Reimbursement Analyst, also known as a Senior Business Intelligence Engineer, is a key member of the Pricer Business and System Support team. This role involves administering complex Medicaid provider reimbursement methodologies and supporting existing Medicaid operations while expanding into new states. The team’s responsibilities are evolving to meet increased demands.

Responsibilities:

1. Implement, maintain, and support Medicaid provider reimbursement for hospitals and facilities.
2. Collaborate with IT, vendor partners, Medicaid operations, claims, and other teams involved in Medicaid administration at Humana.
3. Develop expertise in Medicaid reimbursement methodologies, including complex grouping concepts such as EAPG, APR-DRG, MS-DRG.

Within the INPS department under PPNO, the role includes:

1. Researching state-specific Medicaid reimbursement methodologies.
2. Reviewing Medicaid RFPs and contracts for reimbursement requirements.
3. Supporting new Medicaid pricer implementations, including reviewing vendor specifications, identifying system changes, developing requirements, and testing.
4. Maintaining Medicaid pricers, ensuring quality and compliance.
5. Analyzing root causes of issues and developing solutions.
6. Working with IT and vendors to resolve issues.
7. Developing policies and procedures.
8. Identifying automation and process improvement opportunities.
9. Resolving provider reimbursement inquiries.

Use your skills to make an impact

Required Qualifications

1. 3+ years researching Medicaid hospital reimbursement methodologies involving MS-DRG, APR-DRG, APC, or EAPG.
2. 2+ years understanding MS-DRG, APR-DRG, and/or EAPG grouper logic.
3. Experience reviewing facility claims.
4. Proficiency in Microsoft Excel, including data analysis, pivot tables, VLOOKUP, etc.

Preferred Qualifications

1. Experience resolving provider reimbursement inquiries.
2. Experience with Optum Rate Manager, WebStrat, or PSI applications.
3. Interaction with State Medicaid or Federal agencies.
4. Intermediate skills in Microsoft Access.

Additional Information

1. This is a remote, work-from-home position based anywhere in the U.S.
2. Occasional travel for training or meetings may be required.
3. Scheduled hours: 40 per week.
4. Salary range: $89,000 - $121,400 annually, with potential bonuses.
5. Humana offers comprehensive benefits supporting health, wellness, and financial security.
6. Application deadline: 05-22-2025.

About us

Humana Inc. (NYSE: HUM) is dedicated to putting health first through innovative insurance and healthcare services, improving quality of life for diverse populations.

Equal Opportunity Employer

Humana values diversity and inclusion, ensuring employment decisions are based on valid job requirements and free from discrimination.