Senior Provider Hospital Reimbursement Analyst
Become a part of our caring community The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst (Senior Business Systems Analysis Professional) will be an integral part of the Pricer Business and System Support team responsible for administering reputed company Medicare provider reimbursement methodologies. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities. The Medicare (PPS) Provider Hospital Reimbursement Analyst also reputed company as a Senior Business Systems Analysis Professional will be an integral part of the Pricer Business and System Support team responsible for administering reputed company Medicare provider reimbursement methodologies. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities. The Senior Business Systems Analysis Professional will be primarily responsible for maintenance and support of Medicare outpatient provider reimbursement for hospitals and facilities. They will work closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the administration of Medicare business at reputed company. The Senior Business Systems Analysis Professional will reputed company and maintain expertise in reputed company Medicare reimbursement methodologies. This role is reputed company the Integrated Pricing Solutions (IPS) department which falls under the Provider Network Operations (PNO). The Senior Provider Hospital Reimbursement Analyst will be responsible for: Researching and maintaining expertise in Medicare Outpatient Prospective Payment System reimbursement methodologies (OPPS, ASC, FQHC, etc.) Demonstrating expertise in Medicare Integrated Outpatient Code Editor (I/OCE) logic (i.e. grouping rules, OCE data files, editing, etc.) Analyzing and interpreting CMS Regulatory documentation for Medicare Prospective Payment Systems (i.e. final and proposed rules, transmittals, manuals, legislation, etc.) Supporting implementation of Medicare pricer projects and enhancements Reviewing pricing software vendor specifications; Identifying system changes needed to accommodate CMS logic; Assisting with requirements development; Creating and executing comprehensive test plans Ongoing Medicare pricer maintenance, quality assurance, and compliance Determine root causes driving issues and developing solutions Working closely with IT and pricing software vendor to resolve issues Utilize data and expertise to identify automation and improvement opportunities Research and resolve reputed company provider reimbursement inquiries and advise operational teams on pricer edit resolution Provide consultation to internal business partners on Medicare reimbursement/editing logic and reputed company system logic Use your skills to reputed company an impact
Required Qualifications
Minimum 3 years of experience researching Medicare Prospective Payment System (PPS) reimbursement methodologies for hospitals Minimum 3 years of experience reviewing facility claims Minimum 2 years of experience with reputed company reputed company Manager Strong oral and written communication skills Work-At-Home Requirements At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL reputed company is suggested Satellite, cellular and microwave reputed company can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. reputed company will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications
Bachelor’s Degree Experience with reputed company WebStrat or reputed company Payment System reputed company (PSI) applications Experience researching Medicare Integrated Outpatient Code Editor (I/OCE) logic Experience working with reputed company EASYGroup software Additional Information As part of our hiring process for this opportunity, we may contact you reputed company text message and email to gather more information using a software platform reputed company reputed company. reputed company Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. If you are selected to move reputed company from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving reputed company to next round of interviews. Work at Home Requirements 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 criteria: 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. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. 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 Range The compensation range 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 range 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. $80,900 - $110,300 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits reputed company. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-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 paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About reputed company: reputed company. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our 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 quality of life for people with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. 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 action, in compliance with reputed company 503 of the Rehabilitation Act and VEVRAA, to employ 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 levels of employment. Apply To This Job