Senior Business Intelligence Engineer- Medicaid Hospital Reimbursement

Description

The Senior Business Intelligence Engineer will be a crucial member of the Pricer Business and System Support team in charge of managing complex Medicaid provider reimbursement methodologies. This associate will assist with current Medicaid business as well as expansion into new regions. Due to a growing and constantly evolving workload, the team's makeup will also modify to accommodate a greater set of responsibilities.

Responsibilities

Responsibilities:  The main duties of the Senior Business Intelligence Engineer will be the application, servicing, and support of Medicaid provider compensation for hospitals and facilities. They will coordinate closely with IT, the pricing software provider, CIS BSS, Medicaid operations, claims operations, and other business teams involved in managing Medicaid business at Humana. The Senior Business Intelligence Engineer will cultivate and maintain expertise in complex grouping methods (EAPG, APR-DRG, MS-DRG, etc). This role will be within the Integrated Network Payment Solutions (INPS) department, which is part of the Provider Process and Network Organization (PPNO).

The Senior Business Intelligence Engineer will be responsible for:

• Researching state-specific Medicaid compensation methodologies for hospitals and facilities
• Developing expertise in complex groupers (EAPG, APR-DRG, MS-DRG, etc) used in Medicaid compensation
• Reviewing Medicaid RFPs and state contracts to identify provider compensation requirements
• Supporting the introduction of new Medicaid pricers, which includes:
  • Reviewing the specifications from the pricing software provider;
  • Identifying needed system changes to suit state-specific logic;
  • Assisting in requirements development; and
  • Creating and performing comprehensive test plans
• Constantly maintaining Medicaid pricer, quality assurance, and compliance
• Identifying root causes of issues and constructing solutions
• Cooperating closely with IT and the pricing software provider to resolve issues
• Designing Policies & Procedures
• Identifying potential for automation and improvement
• Researching and resolving provider compensation queries

Required Qualifications

• 3+ years of experience with Medicaid hospital compensation methodologies
• 2+ years experience with researching, reviewing or implementing MS-DRG, APR-DRG and/or EAPG grouper logic
• Experience handling or reviewing facility claims
• Prior professional experience using Microsoft Excel (e.g. performing basic data analysis in excel and using pivot tables and features such as VLOOKUP)
• Abides by Humana's WAH policy listed in additional information

​Preferred Qualifications

• Experience researching and resolving provider compensation queries
• Intermediate Microsoft Access skills

Additional Information

Location: Remote United States

In our hiring process for this opportunity, we will be using a technology called Modern Hire to boost our hiring and decision-making capabilities. Modern Hire will allow us to quickly connect and garner valuable information from you regarding your relevant skills and experience at a time that suits your schedule.

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 standards:

Minimum download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; a wireless, wired cable or DSL connection is suggested

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

Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office employees with phone equipment that meets the business requirements for their position/job.

Employees must work from a dedicated space free from continual interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Pay Range

The pay range indicated below is a good faith estimation 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 decisions will vary based on relevant job skills, knowledge, experience, education, certifications, etc.

 

$78,800 - $108,500 per year

 

This role is eligible for a bonus incentive plan. This opportunity will be based on company and/or individual performance.

Description of Benefits

Humana, Inc. and its linked subsidiaries (combined as “Humana”) offer competitive benefits to support the holistic well-being of the associate. Associate benefits are designed to promote personal wellness and smart healthcare decisions for you and your family, knowing that your life extends beyond work. Our benefits include medical, dental, and vision benefits, a 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 other opportunities.