Payment Integrity Business Analyst II

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

Key Details: 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.

Preferred qualifications include experience in Payment Integrity and healthcare claims auditing, a medical coding certification, strong analytical and root cause analysis skills, advanced proficiency in Excel, and experience working with ticketing systems.

• 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.

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

By applying to this requisition, you acknowledge and understand that you may be considered for other job opportunities for which Centene believes you may be qualified.

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.
 

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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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