Coding Business Analyst II - Policy Review

Centene Corporation is a diversified, national organization transforming the health of communities. The Coding Business Analyst II - Policy Review role involves performing analysis to ensure compliance and accuracy of payment policies, while supporting business initiatives through data analysis and process improvement.

Responsibilities:

• 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

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 and experience in benefits, pricing, contracting or claims
• Knowledge of provider reimbursement methodologies
• Previous structured testing experience
• 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