Senior Provider Hospital Reimbursement Analyst

Join our compassionate community dedicated to prioritizing health The Senior Provider Hospital Reimbursement Analyst plays a vital role in the Pricer Business and System Support team, focusing on complex Medicare provider reimbursement methodologies. As our team expands to meet evolving business demands, your skills will be key to supporting our goals. This role primarily involves maintaining and supporting Medicare outpatient provider reimbursement for hospitals and facilities. You will collaborate with IT, pricing software vendors, claims operations, and other business teams involved in administering Medicare business. You will develop and maintain expertise in intricate Medicare reimbursement methods within the Integrated Pricing Solutions (IPS) department of the Provider Process and Network Organization (PPNO). The Senior Provider Hospital Reimbursement Analyst will be responsible for: Researching and mastering Medicare Outpatient Prospective Payment System reimbursement methodologies (e.g., OPPS, ASC, FQHC). Exhibiting deep knowledge of Medicare Integrated Outpatient Code Editor (I/OCE) logic, including grouping rules and data files. Analyzing and interpreting CMS regulations related to Medicare Prospective Payment Systems, including final and proposed rules. Supporting Medicare pricer project implementations and enhancements. Reviewing vendor specifications and identifying necessary system changes to align with CMS logic. Assisting in the development of requirements and executing comprehensive test plans. Ongoing management of Medicare Pricer maintenance, quality assurance, and compliance processes. Identifying root causes of issues and developing effective solutions. Collaborating with IT and pricing software vendors to resolve operational challenges. Utilizing your expertise to pinpoint opportunities for automation and improvement. Researching and resolving intricate provider reimbursement inquiries, advising operational teams on Pricer edit resolutions. Consulting with internal business partners on Medicare reimbursement and editing logic. Make your skills count by making a difference Work-At-Home Requirements Must be able to provide a high-speed DSL or cable modem for a home office. California residents working from home will be reimbursed for their internet expenses. A minimum speed of 25x10 (25mbps download and 10mbps upload) is required for optimal performance. Satellite and wireless internet services are not permitted for this position. A quiet and dedicated workspace is essential to safeguard member PHI/HIPAA information. Travel: Although this role is remote, occasional travel to Humana's offices for training or meetings may be necessary. Scheduled Weekly Hours 40 Compensation Range The salary range displayed below reflects a good faith estimate for full-time (40 hours per week) roles at the time of posting. Individual pay may vary based on geographic location and the candidate's skills, knowledge, experience, and education. $89,000 - $121,400 per year This position is eligible for a bonus incentive plan based on company and/or individual performance. Benefit Overview Humana Inc. provides a competitive benefits package supporting overall well-being, including medical, dental, and vision coverage, a 401(k) retirement plan, paid time off (including personal holidays and volunteer time off), short- and long-term disability, life insurance, and additional opportunities. Application Deadline: 04-16-2026 About Us Humana Inc. is dedicated to putting health first for our teammates, customers, and communities. Through our insurance and healthcare services, we facilitate better healthcare outcomes for millions, improving quality of life for those with Medicare, Medicaid, individuals, families, and military personnel. Equal Opportunity Employer Humana is an equal opportunity employer and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. Our commitment to diversity and inclusion in employment extends to all employment actions, including recruitment, hiring, promotion, and compensation.

Created: 2026-03-04