Coding Business Analyst II - Content Updates

Centene Corporation • Remote-MO, MI

1d • $56,200 - $101,000 • Hybrid

About The Position

Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. This role performs various analysis and interpretation to link business needs and objectives for assigned function, ensuring our internal claims coding editors remain accurate, up to date, and compliant. The position involves reviewing, analyzing, and interpreting coding, reimbursement, and regulatory guidelines to ensure organizational compliance and payment integrity. It also includes developing, implementing, and maintaining Payment Policies, reimbursement methodologies, and claims editing logic to support accurate claims adjudication. The role requires monitoring, reporting on, and tracking regulatory, coding, and policy updates, ensuring timely implementation and communication of changes across impacted stakeholders. Additionally, it supports business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems, identifying and analyzing user requirements, procedures, and problems to improve existing processes, and performing detailed analysis on assigned projects, recommending potential business solutions and assisting with implementation. The position also involves identifying ways to enhance performance management and operational reports related to new business implementation processes, developing and incorporating organizational best practices into business applications, leading problem-solving and coordination efforts between various business units, and assisting with formulating and updating departmental policies and procedures. The role also includes performing other duties as assigned and complying with all policies and standards.

Requirements

• Bachelor’s degree in related field or equivalent experience.
• 2+ years of business process analysis, preferably healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis experience.
• Knowledge of managed care information systems.
• Experience in benefits, pricing, contracting or claims preferred.
• Knowledge of provider reimbursement methodologies preferred.
• Previous structured testing experience preferred.
• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Nice To Haves

• Coding certification such as a CPC or similar.
• Claims coding appeals and auditing experience.
• Claims research experience.
• Excel skills with pivot tables and VLOOKUPs.

Responsibilities

• Ensuring our internal claims coding editors remain accurate, up to date, and compliant.
• Review, analyze, and interpret coding, reimbursement, and regulatory guidelines to ensure organizational compliance and payment integrity.
• Develop, implement, and maintain Payment Policies, reimbursement methodologies, and claims editing logic to support accurate claims adjudication.
• Monitor, report on, and track regulatory, coding, and policy updates, ensuring timely implementation and communication of changes across impacted stakeholders.
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems.
• Identify and analyze user requirements, procedures, and problems to improve existing processes.
• Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation.
• Identify ways to enhance performance management and operational reports related to new business implementation processes.
• Develop and incorporate organizational best practices into business applications.
• Lead problem solving and coordination efforts between various business units.
• Assist with formulating and updating departmental policies and procedures.
• Performs other duties as assigned.
• Complies with all policies and standards.

Benefits

• competitive pay
• health insurance
• 401K
• stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level