Principal Consultant, Medicaid
Model N- Full Time
- Expert & Leadership (9+ years)
Become a part of our caring community and help us put health first. The Medicaid (PPS) Provider Hospital Reimbursement Analyst, also known as a Senior Business Intelligence Engineer, will be an integral part of the Pricer Business and System Support team. This role is responsible for administering complex Medicaid provider reimbursement methodologies and will support existing Medicaid business as well as expansion into new states. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate increased responsibilities.
The Senior Business Intelligence Engineer will be primarily responsible for the implementation, maintenance, and support of Medicaid provider reimbursement for hospitals and facilities. They will work closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid business at Humana.
The Senior Business Intelligence Engineer will develop and maintain expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, APR-DRG, MS-DRG, etc.). This role is within the Integrated Network Payment Solutions (INPS) department, which falls under the Provider Process and Network Organization (PPNO).
The Senior Business Intelligence Engineer will be responsible for:
Use your skills to make an impact!
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits.
Health insurance provider for seniors and military
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.