Senior Hospital Reimbursement Analyst

This is a fully remote position, open to applicants in Kentucky, +4 more states.

📋 Description

• Conducting research and maintaining proficiency in Medicare Outpatient Prospective Payment System reimbursement methodologies (OPPS, ASC, FQHC, etc.)

• Exhibiting proficiency in the Medicare Integrated Outpatient Code Editor (I/OCE) logic (including grouping rules, OCE data files, editing, etc.)

• Analyzing and interpreting CMS Regulatory documentation related to Medicare Prospective Payment Systems (such as final and proposed rules, transmittals, manuals, legislation, etc.)

• Assisting in the implementation of Medicare pricer projects and enhancements

• Reviewing specifications from pricing software vendors; identifying necessary system changes to align with CMS logic; aiding in the development of requirements; creating and executing thorough test plans

• Ongoing maintenance, quality assurance, and compliance of Medicare pricer systems

• Identifying root causes of issues and formulating solutions

• Collaborating closely with IT and pricing software vendors to address issues

• Leveraging data and expertise to pinpoint automation and enhancement opportunities

• Investigating and resolving complex provider reimbursement inquiries while advising operational teams on pricer edit resolutions

• Offering consultation to internal business partners regarding Medicare reimbursement/editing logic and Humana system logic

⛳️ Requirements

• At least 3 years of experience in researching Medicare Prospective Payment System (PPS) reimbursement methodologies for hospitals

• A minimum of 3 years of experience in reviewing facility claims

• At least 2 years of experience with Optum Rate Manager

• Excellent oral and written communication skills

🏝️ Benefits

• Medical, dental, and vision benefits

• 401(k) retirement savings plan

• Paid time off, including company holidays, personal holidays, and paid parental and caregiver leave

• Short-term and long-term disability

• Life insurance

• Numerous other opportunities