You could be the one who changes everything for our 28 million members. 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.
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.
Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function.
- 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.
Education/Experience: 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 and exp