Payment Integrity Business Analyst II

Centene Corporation is a healthcare company focused on connecting people to the care they need and improving healthcare access and effectiveness. The Payment Integrity Business Analyst II analyzes claims, payment integrity opportunities, business requirements, and processes while supporting system implementation, testing, reporting, and cross-functional problem solving.

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

Requirements:

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
• 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
• 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
• Knowledge of managed care information systems and experience in benefits, pricing, contracting or claims
• Knowledge of provider reimbursement methodologies
• Previous structured testing experience