Senior Provider Hospital Reimbursement Analyst

📋 Description

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

• Demonstrating proficiency in 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.)

• Supporting the implementation of Medicare pricer projects and enhancements

• Reviewing specifications from pricing software vendors

• Identifying necessary system changes to accommodate CMS logic

• Assisting in the development of requirements

• Creating and executing detailed test plans

• Performing ongoing maintenance, quality assurance, and compliance for the Medicare Pricer

• Identifying root causes of issues and developing effective solutions

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

• Leveraging data and expertise to uncover automation and improvement opportunities

• Researching and resolving complex provider reimbursement inquiries while advising operational teams on Pricer edit resolutions

• Providing 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 resolving facility claim inquiries

• At least 2 years of experience in researching Medicare Integrated Outpatient Code Editor (I/OCE) logic

• Minimum of 1 year of experience working with Optum EASYGroup software

• Strong verbal and written communication skills

🏝️ Benefits

• Medical, dental, and vision benefits

• 401(k) retirement savings plan

• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)

• Short-term and long-term disability

• Life insurance

• Numerous other opportunities