Job Title

Join our dedicated community focused on improving health outcomes The Senior Hospital Reimbursement Analyst is a critical member of the Pricer Business and System Support team, specializing in complex Medicare provider reimbursement strategies. As we grow to meet changing business challenges, your expertise will be essential in achieving our objectives. This position primarily focuses on maintaining and supporting Medicare outpatient provider reimbursement for hospitals and facilities. You will work closely with IT, pricing software vendors, claims operations, and various business teams involved in administering Medicare services. You'll develop and sustain a strong understanding of complex Medicare reimbursement methods within the Integrated Pricing Solutions (IPS) department of the Provider Process and Network Organization (PPNO). Key Responsibilities of the Senior Hospital Reimbursement Analyst include: Researching and mastering Medicare Outpatient Prospective Payment System reimbursement methods (e.g., OPPS, ASC, FQHC). Demonstrating profound 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 the implementation and enhancement of Medicare pricer projects. Reviewing vendor specifications to identify necessary system changes aligned with CMS logic. Assisting in the development of requirements and executing detailed test plans. Managing ongoing 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 address operational challenges. Utilizing your expertise to identify opportunities for automation and improvement. Researching and resolving complex provider reimbursement inquiries, advising operational teams on Pricer edit resolutions. Consulting with internal business partners on matters of Medicare reimbursement and editing logic. Your skills can make a significant impact! Work-At-Home Requirements Must provide a high-speed DSL or cable modem for your home office. California residents working from home will receive reimbursement for their internet costs. 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 dedicated, quiet workspace is essential to protect member PHI/HIPAA information. Travel: Although this role is primarily remote, occasional travel to Humana's offices for training or meetings may be necessary. Scheduled Weekly Hours 40 Compensation Range The displayed salary range reflects a good faith estimate for full-time (40 hours per week) positions at the time of posting. Actual pay may vary based on geographic location, as well as the candidate's skills, knowledge, experience, and education. $89,000 - $121,400 per year This position is eligible for a performance-based bonus incentive program. Benefits Overview Humana Inc. offers a competitive benefits package that supports the overall well-being of our employees, 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 numerous additional opportunities. Application Deadline: 04-16-2026 About Us Humana Inc. is committed to prioritizing health for our teammates, customers, and communities. Through our insurance and healthcare services, we enhance 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 dedication to diversity and inclusion is reflected in all aspects of employment, including recruitment, hiring, promotion, and compensation.