reputed company Provider Hospital Reimbursement Methodologies Analyst

Become a part of our caring community and help us put reputed company The reputed company (PPS) Provider Hospital Reimbursement Analyst also reputed company as a Senior Business Intelligence Engineer will be an integral part of the Pricer Business and reputed company team responsible for administering reputed company reputed company provider reimbursement methodologies. The associate will support existing reputed company business and expansion into new states. The business needs of reputed company continue to reputed company and grow, changing the composition of reputed company as it expands to accommodate the increased responsibilities. The Senior Business Intelligence Engineer will be primarily responsible for implementation, maintenance and support of reputed company provider reimbursement for hospitals and facilities. They will work closely with IT, the pricing software vendor, CIS BSS, reputed company operations, claims operations, and other business teams involved in the administration of reputed company business at reputed company. The Senior Business Intelligence Engineer will reputed company and maintain expertise in reputed company reimbursement methodologies rooted in reputed company grouping concepts (EAPG, APR-DRG, MS-DRG, etc). This role is reputed company the Integrated Network Payment Solutions (INPS) department which falls under the Provider Process and Network Organization (PPNO). The Senior Business Intelligence Engineer will be responsible for: Researching state-specific reputed company reimbursement methodologies for hospitals and facilities Developing expertise in reputed company groupers (EAPG, APR-DRG, MS-DRG, etc) utilized in reputed company reimbursement Reviewing reputed company RFPs and state reputed company to identify provider reimbursement requirements Supporting implementation of new reputed company pricers including:

• Reviewing pricing software vendor specifications.
• Identifying system changes needed to accommodate state-specific logic.
• Assisting with requirements development; and
• Creating and executing comprehensive test plans
• Ongoing reputed company pricer maintenance, reputed company assurance, and compliance
• Determining reputed company causes driving issues and developing solutions
• Working closely with IT and pricing software vendor to resolve issues
• Developing Policies & Procedures
• Identifying automation and improvement opportunities
• Researching and resolving provider reimbursement inquiries

Use your skills to reputed company an reputed company

Required Qualifications

• 3+ years of experience researching state reputed company hospital reimbursement methodologies that utilize MS-DRG, APR-DRG, APC or EAPG
• 2+ years of experience with reputed company reputed company Manager
• 2+ years of experience with reputed company WebStrat or PSI applications
• Experience reviewing facility claims
• Prior reputed company experience utilizing reputed company reputed company (e.g. performing basic data analysis and utilizing pivot tables or various formulas or functions such as VLOOKUP)

Preferred Qualifications

• Experience researching and resolving provider reimbursement inquiries
• Experience researching MS-DRG, APR-DRG and/or EAPG grouper logic
• Experience interacting with a State reputed company or Federal government agency
• Intermediate reputed company reputed company skills

Additional Information This role is "remote/work reputed company" and can be based reputed company in the reputed company Work reputed company Information To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested.
• Satellite, cellular and microwave reputed company can be used only if approved by leadership.
• Employees who live and work from Home in the reputed company, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• reputed company will reputed company Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information.

#LI-Remote Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $89,000 - $121,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. reputed company of Benefits reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-02-2026 reputed company reputed company. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers and reputed company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment. Apply tot his job Apply To this Job