Description
The Provider Business Intelligence teams are committed to effective and efficient business solutions for quality assurance and risk mitigation in implementing Humana’s Provider Medicare/Medicaid contracts. We are in search of a Sr Business Intelligence Engineer to provide support to our Provider Facility and Physician accounts to ensure we are meeting contractual requirements and expected timelines for the respective contracts.
Responsibilities
The Senior Business Intelligence Engineer will be responsible for:
• Interpret Physician reimbursement methodologies and contracts to oversee the loading of Medicaid fee schedules and Contract Information Systems (CIS) reimbursement terms.
• Monitoring and analyzing State regulations/guidelines for relevant changes and tracking changes through implementation
• 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.
• Interact with Markets, Claims, Policy and Process and Project Managers.
• Create and maintain FSM Medicaid Process documents.
Required Qualifications –
- 1+ years of experience with Medicaid or Medicare Provider Claims Adjudication and ContractReimbursement
- Prior professional experience utilizing Microsoft Office Applications
- Prior professional experience utilizing critical thinking, root cause analysis and problem-solving skills
- 1+ years experience in Research, Analysis, Documentation, and Interpretation for Provider Reimbursement Programs in New/Existing Medicaid States.
- Prior professional experience in presenting verbal and written communication to senior and executive leadership
- Meet WAH Connectivity Requirements in additional information
Preferred Qualifications
- Bachelor’s degree
- Contract Information System (CIS) Knowledge
Additional Information:
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
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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$78,800 – $108,350 per year
This 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.