Coding Business Analyst II - Policy Review

Centene Corporation•St. David's, MI

1d•$56,200 - $101,000•Hybrid

About The Position

Centene is seeking a Coding Business Analyst II to perform various analysis and interpretation to link business needs and objectives for assigned function. This role involves detailed reviews of state-specific and corporate Payment policies for Compliance and Governance, ensuring policies are accurate and up-to-date with guidelines. The analyst will review, analyze, and interpret coding, reimbursement, and regulatory guidelines to ensure organizational compliance and payment integrity. They will also develop, implement, and maintain Payment Policies, reimbursement methodologies, and claims editing logic to support accurate claims adjudication. Additionally, the role includes monitoring, reporting on, and tracking regulatory, coding, and policy updates, supporting business initiatives through data analysis, and identifying and analyzing user requirements to improve existing processes. The analyst will perform detailed analysis on assigned projects, recommend potential business solutions, and assist with implementation. They will also identify ways to enhance performance management and operational reports, develop and incorporate organizational best practices, lead problem-solving efforts, and assist with formulating and updating departmental policies and procedures. This position is for an individual authorized to work in the U.S. without sponsorship.

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.
Authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

Nice To Haves

Coding certification such as a CPC or similar.
Claims coding appeals or revenue cycle experience.
Claims research experience.
Excel skills with pivot tables and VLOOKUPs.
Knowledge of provider reimbursement methodologies.
Previous structured testing experience.

Responsibilities

Perform various analysis and interpretation to link business needs and objectives for assigned function.
Conduct detailed reviews of both state specific and corporate Payment policies for Compliance and Governance ensuring policies are accurate and up to date with guidelines.
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.