The Business Systems Analysis Professional 2 will build and maintain working knowledge of Medicaid reimbursement methodologies, including complex grouping concepts such as EAPG, APR-DRG, MS-DRG, and related facility reimbursement logic. This role is within the Integrated Pricing Solutions (IPS) department which falls under the Provider Network Operations (PNO) organization.
Researching state-specific Medicaid reimbursement methodologies for hospitals and facilities
Developing expertise in complex groupers, including EAPG, APR-DRG, MS-DRG, used in Medicaid reimbursement
Monitoring state Medicaid and Solventum websites for publication of provider reimbursement changes
Analyzing updates for impacts to Medicaid pricer reimbursement
Reviewing software vendor release notes
Developing and executing test plans for Medicaid pricer updates
Partnering with IT and pricing software vendor to resolve issues
Researching and resolving provider reimbursement inquiries
Identifying patterns in inquiries and translating insights into actionable process improvement and automation opportunities
Performing root cause analysis and escalating complex issues to senior team members, or leadership as appropriate
Required Qualifications
Minimum 2 years of experience researching state Medicaid hospital reimbursement methodologies that utilize EAPG, APR-DRG, or MS-DRG
Experience reviewing facility claims
Experience researching and resolving provider reimbursement inquiries
Experience testing system updates or enhancements
Prior professional experience utilizing Microsoft Excel (e.g. performing basic data analysis and utilizing pivot tables, formulas and functions)
Preferred Qualifications
Experience with Optum Rate Manager
Experience with Optum WebStrat or PSI applications
Experience researching MS-DRG, APR-DRG and/or EAPG grouper logic
Experience interacting with a State Medicaid or Federal government agency
Intermediate Microsoft Access skills
Work at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$60,800 - $82,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 08-13-2026
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana will never ask, nor require a candidate to provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact yourcareer@humana.com to validate the request
At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
