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.
 

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.

Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function.

• 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.

Benefits and Payment Configuration:
Compliance Coding/Prepay Compliance (Payment Integrity): 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 preferred. Knowledge of provider reimbursement methodologies preferred. Previous structured testing experience preferred.

Encounters: Bachelor’s degree in related field or equivalent experience. 2+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry or 1+ years of managed care encounters experience. Knowledge of claims and/or encounter processing and data analysis experience preferred. Understanding of HIPAA transactions (i.e. 837, 999, 824, 277) preferred. Knowledge of managed care information systems and experience in SQL scripting preferred.

Provider Data: Bachelor’s degree in related field or equivalent experience. 2+ years of business process analysis (documenting business process, gathering requirements) experience in healthcare industry and/or working in a data driven environment. Knowledge of data migration, software enhancement/planning, and Agile preferred.

Member & Provider Solutions: Bachelor’s degree in related field or equivalent experience. 2+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry and/or customer service or enrollment functions. Experience managing projects with a high reliance on technology. Knowledge of data integration, software enhancements/planning and Agile preferred.

Pay Range: $55,100.00 - $99,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act