Reimbursement Analyst Jobs for OPT Students
Reimbursement Analyst roles sit at the intersection of healthcare billing, insurance claims, and regulatory compliance, making them a strong fit for F-1 OPT students with degrees in health administration, finance, or business. Most positions qualify as specialty occupations, supporting both standard 12-month OPT and the 24-month STEM extension.
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Get Access To All JobsBecome a part of our caring community and help us put health first
The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst (Senior Business Systems Analysis Professional) will be an integral part of the Pricer Business and System Support team responsible for administering complex Medicare provider reimbursement methodologies. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities. The Senior Provider Hospital Reimbursement Analyst will be primarily responsible for maintenance and support of Medicare outpatient provider reimbursement for hospitals and facilities. They will work closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the administration of Medicare business at Humana. Senior Provider Hospital Reimbursement Analyst will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated Pricing Solutions (IPS) department which falls under the Provider Process and Network Organization (PPNO).
The Senior Provider Hospital Reimbursement Analyst will be responsible for:
- Researching and maintaining expertise in Medicare Outpatient Prospective Payment System reimbursement methodologies (OPPS, ASC, FQHC, etc.)
- Demonstrating expertise in Medicare Integrated Outpatient Code Editor (I/OCE) logic (i.e. grouping rules, OCE data files, editing, etc.)
- Analyzing and interpreting CMS Regulatory documentation for Medicare Prospective Payment Systems (i.e. final and proposed rules, transmittals, manuals, legislation, etc.)
- Supporting implementation of Medicare pricer projects and enhancements
- Reviewing pricing software vendor specifications
- Identifying system changes needed to accommodate CMS logic
- Assisting with requirements development
- Creating and executing comprehensive test plans
- Ongoing Medicare Pricer maintenance, quality assurance, and compliance
- Determining root causes driving issues and developing solutions
- Working closely with IT and pricing software vendor to resolve issues
- Utilizing data and expertise to identify automation and improvement opportunities
- Researching and resolving complex provider reimbursement inquiries and advise operational teams on Pricer edit resolution
- Providing consultation to internal business partners on Medicare reimbursement/editing logic and Humana system logic
Use your skills to make an impact
Required Qualifications
- Minimum 3 years of experience researching Medicare Prospective Payment System (PPS) reimbursement methodologies for hospitals
- Minimum 3 years of experience resolving facility claim inquiries
- Minimum 2 years of experience researching Medicare Integrated Outpatient Code Editor (I/OCE) logic
- Minimum 1 year of experience working with Optum EASYGroup software
- Strong oral and written communication skills
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
Preferred Qualifications
- Bachelor’s Degree
- Experience with Optum Rate Manager
- Experience with Optum WebStrat or Optum Payment System Interface (PSI) applications
Additional Information
- As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
- If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
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.
$80,900 - $110,300 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.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
Become a part of our caring community and help us put health first
The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst (Senior Business Systems Analysis Professional) will be an integral part of the Pricer Business and System Support team responsible for administering complex Medicare provider reimbursement methodologies. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities. The Senior Provider Hospital Reimbursement Analyst will be primarily responsible for maintenance and support of Medicare outpatient provider reimbursement for hospitals and facilities. They will work closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the administration of Medicare business at Humana. Senior Provider Hospital Reimbursement Analyst will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated Pricing Solutions (IPS) department which falls under the Provider Process and Network Organization (PPNO).
The Senior Provider Hospital Reimbursement Analyst will be responsible for:
- Researching and maintaining expertise in Medicare Outpatient Prospective Payment System reimbursement methodologies (OPPS, ASC, FQHC, etc.)
- Demonstrating expertise in Medicare Integrated Outpatient Code Editor (I/OCE) logic (i.e. grouping rules, OCE data files, editing, etc.)
- Analyzing and interpreting CMS Regulatory documentation for Medicare Prospective Payment Systems (i.e. final and proposed rules, transmittals, manuals, legislation, etc.)
- Supporting implementation of Medicare pricer projects and enhancements
- Reviewing pricing software vendor specifications
- Identifying system changes needed to accommodate CMS logic
- Assisting with requirements development
- Creating and executing comprehensive test plans
- Ongoing Medicare Pricer maintenance, quality assurance, and compliance
- Determining root causes driving issues and developing solutions
- Working closely with IT and pricing software vendor to resolve issues
- Utilizing data and expertise to identify automation and improvement opportunities
- Researching and resolving complex provider reimbursement inquiries and advise operational teams on Pricer edit resolution
- Providing consultation to internal business partners on Medicare reimbursement/editing logic and Humana system logic
Use your skills to make an impact
Required Qualifications
- Minimum 3 years of experience researching Medicare Prospective Payment System (PPS) reimbursement methodologies for hospitals
- Minimum 3 years of experience resolving facility claim inquiries
- Minimum 2 years of experience researching Medicare Integrated Outpatient Code Editor (I/OCE) logic
- Minimum 1 year of experience working with Optum EASYGroup software
- Strong oral and written communication skills
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
Preferred Qualifications
- Bachelor’s Degree
- Experience with Optum Rate Manager
- Experience with Optum WebStrat or Optum Payment System Interface (PSI) applications
Additional Information
- As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
- If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
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.
$80,900 - $110,300 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.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
How to Get Visa Sponsorship as a Reimbursement Analyst
Confirm your degree supports the specialty occupation standard
Reimbursement Analyst roles typically require a degree in health administration, finance, accounting, or business. Before applying, verify your degree field aligns with the job description to support both your OPT authorization and a future H-1B petition.
Target employers with established healthcare billing departments
Large hospital systems, insurance carriers, and revenue cycle management firms file H-1B petitions regularly. These employers have immigration infrastructure in place, making the transition from OPT to sponsored status significantly more straightforward than smaller healthcare practices.
Highlight coding certifications and software proficiency
Employers hiring on OPT want candidates who can contribute immediately. Certifications in CPT or ICD-10 coding, and proficiency with tools like Epic or Meditech, signal readiness and reduce the perceived risk of sponsoring an international candidate.
Apply before your OPT start date to account for processing time
OPT authorization can take 90 days or more to process. Apply for positions two to three months before your program end date so your EAD arrives before you need to start, avoiding gaps that could complicate your employment timeline.
Address your OPT timeline directly in interviews
Proactively explaining that you have 12 months of OPT, with a potential 24-month STEM extension, gives employers a clear picture of your work authorization window and reduces hesitation about offering you a full-time reimbursement role.
Understand which STEM CIP codes apply to your degree
STEM OPT extension eligibility depends on your degree's Classification of Instructional Programs code. Finance and information systems degrees often qualify. Confirm your degree's CIP code with your DSO before targeting roles that assume a 36-month total OPT window.
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Get Access To All JobsFrequently Asked Questions
Can I work as a Reimbursement Analyst on F-1 OPT?
Yes. Reimbursement Analyst positions generally qualify as specialty occupations under OPT rules because they require at least a bachelor's degree in a specific field such as health administration, finance, or business. Your EAD card authorizes full-time employment in a role directly related to your degree, which Reimbursement Analyst work typically satisfies.
Do Reimbursement Analyst jobs qualify for the 24-month STEM OPT extension?
They can, depending on your degree. If your bachelor's or master's degree is in a STEM-designated field such as health informatics, information systems, or finance and your employer is enrolled in E-Verify, you may qualify for the 24-month extension. Confirm your degree's CIP code with your designated school official before assuming eligibility.
Where can I find Reimbursement Analyst jobs that offer OPT sponsorship?
Migrate Mate is built specifically for F-1 OPT students and filters jobs by visa sponsorship willingness, so you can browse Reimbursement Analyst openings without manually screening each employer. Large hospital networks, revenue cycle management companies, and national insurance carriers are the most consistent sources of sponsored roles in this field.
Will employers sponsor me for an H-1B after my OPT ends?
Many large healthcare employers and revenue cycle firms do sponsor H-1B petitions for Reimbursement Analysts, particularly after seeing performance during the OPT period. The role's alignment with the specialty occupation standard makes it a defensible H-1B petition. Smaller practices are less likely to have the legal infrastructure to support sponsorship.
What degree is required for a Reimbursement Analyst role on OPT?
Most employers expect a bachelor's degree in health administration, health information management, finance, accounting, or business administration. Your degree field must be directly related to the position to satisfy OPT's requirement that employment align with your program of study. A mismatch between your degree and the job description can jeopardize both your OPT status and a future H-1B petition.
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