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Physician Reimbursement Senior Analysis Professional known as a Senior Business Intelligence Engineer at Humana will be an integral part of our core cross-functional team responsible for ensuring timely and accurate Physician reimbursement. The business needs of the team, Integrated Network Payment Solutions (INPS), continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities.

Physician fee schedules come from a number of sources and encompass the entire gamut of services rendered by providers.New policies are constantly enacted, as well as new implementations and the need for new pricing procedures in order to develop and maintain Humana’s fee schedules.

For this role, Fee Schedule Maintenance is looking for someone who can interpret reimbursement language and initiatives (contracts, legislation, etc…), who understands provider payment methodologies and policies, and can help decipher, integrate, troubleshoot and even help build out how it all works in our systems. We’re also looking for someone who is comfortable working with large datasets – ideally will be able to pull and transform their own data and is able to work with IT and dev resources to help maintain the data in our systems.

Our projects typically include building out reimbursement terms within Humana systems, understanding the relationship between those systems and knowing how to efficiently implement complex builds. The candidate needs to be familiar with claim processes in order to research and troubleshoot existing systematic pricing mechanisms and to help implement new ones.

Use your skills to make an impact

Required Qualifications

• 2 or more years of Experience in interpreting provider contracts and reimbursement legislation policy or related area.

• 3 or more years of Claims research experience or related area (reporting and individual claim views).

• Advanced knowledge of Microsoft Office Applications, especially Excel and Access

• Experience working with big and complex data sets (flat files, 1mil+ records)

• Experience analyzing data to solve a wide variety of business problems (finding root cause to trending claims issues, etc.)

Preferred Qualifications

• Bachelors Degree

• Experience with project management and/or managing process automations

• Intermediate experience in SQL, and other data systems

• Experience maintaining SharePoint and/or data dashboard solutions (MS Access, Power BI)

Additional information

HireVue Statement

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work at Home Statement

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 connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Employees 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.

Humana will provide Home or Hybrid Home/Office employees 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

#PPNO

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related 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.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

Application Deadline: 12-23-2024

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all 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 all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.