Are you looking to join a team where you can be a part of our important mission of supporting the TRICARE healthcare program for our nation's military? Humana Government Business is a top 10 Department of Defense contractor, with a long history in the TRICARE business and has recently been awarded the T-5 East Region, the next generation of military health contracts. The Business Intelligence Engineer 2 position is a role on the Claims Finance Reimbursement team responsible for TRICARE reimbursement updates and assessing reimbursement program impacts for value-based care. A high degree of claims processing intelligence and an innovative mindset is needed. Come join a team where your business intelligence, claims research, healthcare knowledge, and experience will help our team continue to increase quality, implement reimbursement updates, and identify TRICARE program impact in the East Region.
Researching claims reimbursement (E.g. Federal Register, CMS) to understand provider reimbursement methodologies for potential new business, develop business requirements for implementation of new fee schedules/pricers, as part of a larger project team.
Developing and execute testing plans for new fee schedule/pricer implementations and updates, working with vendor and internal IT teams to resolve defects.
Collaborating with internal business partners for claims processing updates related to pricers and fee schedules, support internal users of the pricers, including providing guidance related to specific edits and answering general questions on the reimbursement methodologies.
Leads project management on claims processing reimbursement inquiries and making determinations on next steps
Provide evidence of fee schedule implementation based on updates published by TRICARE, creating policies and procedures on request.
Our Department of Defense contract requires U.S. citizenship
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
Minimum of 3 years of experience in healthcare operations
Minimum of 3 years claims processing experience (must understand how to research a claim and understand processing guidelines for end to end resolution)
Familiarity with Medicare reimbursement terminology (e.g: DRG, HCPCs, CPT coding, Revenue codes, Outpatient/Inpatient billing)
Intermediate Excel knowledge
Basic PowerPoint knowledge
Basic experience with SQL, or Microsoft Access to pull simple reports and queries
Associates or Bachelors Degree
Previous TRICARE Claims Processing experience
Knowledge of TRICARE
Work at Home Requirements
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
Associates 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 associates 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
Scheduled Weekly Hours
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.