Senior Provider Hospital Reimbursement Analyst

Humana

Senior Provider Hospital Reimbursement Analyst overseeing Medicare outpatient reimbursement processes at Humana. Collaborating with IT and pricing vendors to ensure compliance and optimize systems for complex regulations.

Posted 5/14/2026full-timeRemote • Kentucky, North Carolina, North Dakota, Ohio, Oklahoma • 🇺🇸 United StatesSenior💰 $80,900 - $110,300 per yearWebsite

About the role

Key responsibilities & impact

Researching and maintaining expertise in Medicare Outpatient Prospective Payment System reimbursement methodologies (OPPS, ASC, FQHC, etc.)
Demonstrating expertise in Medicare Integrated Outpatient Code Editor (I/OCE) logic (i.e. grouping rules, OCE data files, editing, etc.)
Analyzing and interpreting CMS Regulatory documentation for Medicare Prospective Payment Systems (i.e. final and proposed rules, transmittals, manuals, legislation, etc.)
Supporting implementation of Medicare pricer projects and enhancements
Reviewing pricing software vendor specifications
Identifying system changes needed to accommodate CMS logic
Assisting with requirements development
Creating and executing comprehensive test plans
Ongoing Medicare Pricer maintenance, quality assurance, and compliance
Determining root causes driving issues and developing solutions
Working closely with IT and pricing software vendor to resolve issues
Utilizing data and expertise to identify automation and improvement opportunities
Researching and resolving complex provider reimbursement inquiries and advise operational teams on Pricer edit resolution
Providing consultation to internal business partners on Medicare reimbursement/editing logic and Humana system logic

Requirements

What you’ll need

Minimum 3 years of experience researching Medicare Prospective Payment System (PPS) reimbursement methodologies for hospitals
Minimum 3 years of experience resolving facility claim inquiries
Minimum 2 years of experience researching Medicare Integrated Outpatient Code Editor (I/OCE) logic
Minimum 1 year of experience working with Optum EASYGroup software
Strong oral and written communication skills

Benefits

Comp & perks

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
many other opportunities

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Medicare Outpatient Prospective Payment SystemMedicare Integrated Outpatient Code EditorCMS Regulatory documentationpricing software specificationstest plansquality assuranceroot cause analysisautomationreimbursement methodologiesfacility claim inquiries

Soft Skills

oral communicationwritten communication