Reimbursement Analyst
EnableCompSalary not specified
Full Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Health InsuranceIndustries
Requirements
- 2 years experience with a coding certification (Industry-recognized coding certification from the AAPC and/or AHIMA)
- Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and HCPCS
- Medical Code editing experience
- Comprehensive knowledge of Microsoft Word, Outlook and Excel
- Strong attention to detail, excellent time management and organizational skills
- Ability to work independently under general instructions and with a team
- Self-provided internet service meeting minimum speeds (25 Mbps download, 10 Mbps upload; wired cable or DSL preferred; satellite/cellular/microwave only if approved)
- Ability to work from a dedicated space lacking ongoing interruptions to protect PHI/HIPAA information
- Flexible availability for Monday-Friday start time between 6am-9am EST (must be available in Eastern Standard Time Zone)
- Preferred: BS in healthcare or business-related field
- Preferred: Knowledge of internal Medical Coverage Policies and Claims Payment Policies
- Preferred: CAS claims processing experience
- Preferred: Experience in data analysis and trend monitoring
Responsibilities
- Performs research, analysis, documentation, and interpretation for provider reimbursement programs
- Identifies reimbursement policy and process recommendations (primarily with respect to proposed new code edits and specifics of existing code edits that are reviewed), ensuring compliance with government regulations, contractual considerations, and relevant business decisions
- Analyzes provider reimbursement patterns and trends
- Begins to influence department’s strategy
- Makes decisions on moderately complex to complex issues regarding technical approach for project components, with work performed without direction
- Exercises considerable latitude in determining objectives and approaches to assignments
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
What certifications are required for this role?
A coding certification from the AAPC and/or AHIMA with 2 years of experience is required.
Is this a remote position?
This is a work-at-home or hybrid home/office position with specific internet speed requirements and equipment provided by Humana.
What are the required technical skills for this job?
The role requires extensive knowledge of medical claims processing, reimbursement methodologies, ICD, CPT, HCPCS, and medical code editing experience, plus comprehensive knowledge of Microsoft Word, Outlook, and Excel.
What are the work hours for this position?
Hours are Monday-Friday with a start time between 6am-9am EST, and candidates must be flexible and available in the Eastern Standard Time Zone.
What soft skills are needed to succeed in this role?
Strong attention to detail, excellent time management, organizational skills, and the ability to work independently under general instructions and with a team are required.
Humana
Health insurance provider for seniors and military
About Humana
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.
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees