Senior Business Intelligence Medicaid Professional

at Humana in Springfield, Illinois, United States

Job Description

Become a part of our caring community and help us put health first

The Senior Business Intelligence Engineer will be an integral part of our core cross-functional team responsible for ensuring timely and accurate Medicaid 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.

Responsibilities: This associate’s primary responsibility will be managing all aspects of Medicaid physician reimbursement, from researching state reimbursement methodologies to the loading and maintenance of rates. Work assignments involve complex issues where the retrieval, manipulation and analysis of data requires an in-depth understanding of reimbursement, coding, physician fee schedules, CIS and Humana’s claims payment platforms.

The Senior Business Intelligence Engineer will be responsible for:

+ Work with moderate to large datasets in order to accurately maintain physician reimbursement terms in Humana systems

+ Researching state Medicaid reimbursement documentation, including fee schedules, administrative code, policy and procedures, etc.

+ Develop and implement efficiencies for existing processes

+ Interpret Physician reimbursement methodologies and contracts to oversee the loading of Medicaid fee schedules and CIS reimbursement terms

+ Creating/loading provider’s rates within Fee Schedule Management system and CIS

+ Develop fee schedule knowledge using multiple data sources including Medicare and Medicaid, CIS logic and Web base fee schedules, etc.

+ IT Liaison – Work with Fee Schedule IT area to create and implement functional changes/improvements to the Fee Schedule Management System

+ Collaborate with Markets, Claims, Policy, Process and Project Managers to accommodate new Medicaid logic and identify the potential for system enhancements

+ Review claims inquiries and issues to determine root cause

+ Interpret requirements and help strategize for the implementation of incoming projects

+ Maintain Medicaid Process documents

Use your skills to make an impact

Required Qualifications

+ 3+ years experience with State Medicaid reimbursement/Fee Schedules

+ 3+ professional experience utilizing/knowledge of core Humana systems including CAS, CIS, and CIS PRO

+ Prior professional experience in understanding healthcare reimbursement related data and provider contract interpretation

+ Prior professional experience utilizing critical thinking and problem-solving skills

+ Prior professional experience working with basic claims or having claims knowledge

+ Meet Humana’s WAH Connectivity Policy (additional information)

Preferred Qualifications

+ Bachelor’s Degree or equivalent experience

+ Experience with Medicare and/or Medicaid

+ Proficiency with MS Excel

+ Proficiency in verbal and written communication to senior and executive leadership

+ Located in Louisville

Additional Information

Hours: Typical business hours, Flexible start time 7-9am;

Location: Flexible Home or Hybrid US

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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 Connectivity

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 recommended; 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

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

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.$78,800 – $108,500 per yearThis 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.

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 because he or she is a protected veteran. 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.