Optum Sql Jobs in Nebraska (NOW HIRING)

About You

The Payer Payment and Reimbursement Analyst will work with the team members in healthcare payment & reimbursement methodologies, laws and regulations under the mentorship and guidance of the Project Manager.

• Tell us about your experience with Payment and Reimbursement Methodologies.
• Are you a team player and a self-motivator?
• What is your experience with conducting business in a way that is credit to a company?
• We are counting on you to manage multiple projects using your problem-solving skills.
• We are looking for someone UNCOMMON. What is uncommon about you?

Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you.

About the Position

• Configure and maintain payment, pricing, and contract logic within healthcare reimbursement systems to ensure accurate claims adjudication.
• Analyze vendor bulletins, regulatory updates, and system changes to assess impact on internal processes, products, and data systems.
• Review and evaluate large healthcare data sets to identify trends, anomalies, and required system or process changes.
• Interpret Medicare, VA, CHAMPVA, and TRICARE policies, including rulings, transmittals, bulletins, manuals, and physician fee schedule data files.
• Collaborate directly with government agencies to clarify new or existing reimbursement and payment policies.
• Translate reimbursement policy updates and payment methodology changes into clear, actionable business requirements for software design and system configuration.
• Develop complex Excel models and formulas to validate, explain, and support payment methodologies.
• Identify claim data characteristics required for testing pricing logic and configuration accuracy.
• Partner with Developers, QA, Data, and Client Services teams to ensure requirements are implemented accurately and on schedule.
• Create and execute test claims for development, UAT, QA, and configuration validation.
• Perform configuration testing and troubleshoot pricing or payment discrepancies.
• Maintain deep knowledge of company products, data, and services, including commercial contracting and reimbursement features.
• Independently evaluate and resolve complex pricing and reimbursement issues while managing multiple priorities.

Core Competencies

• Strong analytical and critical-thinking skills
• High attention to detail and quality
• Ability to synthesize complex policy and data into practical solutions
• Effective collaboration and communication
• Self-directed with strong prioritization skills

Minimum Requirements

• 3-4 years of professional experience in healthcare provider payment and reimbursement.
• Working knowledge of healthcare billing, compliance, and payer reimbursement regulations.
• Experience with professional and institutional payment fee schedules, including but not limited to:
  • Experience with Prospective Payment Systems (PPS), including:
    • DRG, OPPS, Skilled Nursing, Home Health, Hospice, and ASC
• Knowledge of:
  • Critical Access, Sole Community
  • Behavioral Health
  • Inpatient Rehabilitation/Outpatient Rehabilitation
  • Long Term Care Hospital
  • Federally Qualified Health Center
  • Physician Fee Schedule, DME/DEMPOS, Ambulance, AWP, Lab, ESRD, Hospice, Home Health, Anesthesia, ADA
  • Integrated Outpatient Code Editor (I/OCE)
• Ability to collect, research, interpret, and document complex information into clear and concise business requirements.
• Strong interpersonal and cross-functional collaboration skills.
• Working knowledge of provider types, specialties, and their applicable reimbursement methodologies.
• Ability to communicate effectively with diverse internal and external stakeholders.
• SQL reporting experience preferred.

Preferred Requirements

• U.S. Citizenship or naturalized citizenship is required for this position.
• All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.