Payment Integrity Business Analyst II

Centene Corporation•Remote-MO, MI

1d•$56,200 - $101,000•Hybrid

About The Position

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Requirements

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.
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.

Nice To Haves

Experience in Payment Integrity and healthcare claims auditing
A medical coding certification
Strong analytical and root cause analysis skills
Advanced proficiency in Excel
Experience working with ticketing systems

Responsibilities

Research, identify, validate, and document overpaid claims and recovery opportunities through detailed claims analysis, reimbursement review, coding validation, and application of regulatory and payment policy guidelines.
Monitor and analyze recovery concepts and claim outcomes throughout the review lifecycle, collaborating with Medical Economics, Payment Integrity Operations, Claims, and BTS to investigate issues, validate results, and optimize savings performance.
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.