Senior Data Analyst
Nomi HealthFull Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
Candidates must have at least 3 years of experience researching state Medicaid hospital reimbursement methodologies that utilize MS-DRG, APR-DRG, APC, or EAPG. A minimum of 2 years of experience researching MS-DRG, APR-DRG, and/or EAPG grouper logic is required, along with experience processing or reviewing facility claims. Prior professional experience utilizing Microsoft Excel, including performing basic data analysis, using pivot tables, and functions like VLOOKUP, is also necessary.
The Medicaid Provider Hospital Reimbursement Methodologies Analyst will implement, maintain, and support Medicaid provider reimbursement for hospitals and facilities. Responsibilities include researching state-specific Medicaid reimbursement methodologies, developing expertise in complex groupers, and reviewing Medicaid RFPs and state contracts. The analyst will support new Medicaid pricer implementations by reviewing vendor specifications, identifying system changes, assisting with requirements development, and executing test plans. They will also perform ongoing maintenance, quality assurance, and compliance for Medicaid pricers, determine root causes of issues and develop solutions, work with IT and vendors to resolve problems, develop policies and procedures, identify automation opportunities, and research and resolve provider reimbursement inquiries.
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.