Payment Integrity Business Analyst II

🔥 13 hours ago

🌵 Arizona, Florida, +4 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🌲 North Carolina – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Business Analyst

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Perform analysis and interpretation to link business needs and objectives for the assigned function • Research, identify, validate, and document overpaid claims and recovery opportunities through 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 • Collaborate 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 business solutions, and assist with implementation • 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 • Perform other duties as assigned • Comply 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 preferred • Medical coding certification preferred • Strong analytical and root cause analysis skills preferred • Advanced proficiency in Excel preferred • Experience working with ticketing systems preferred • Knowledge of managed care information systems preferred • Experience in benefits, pricing, contracting or claims preferred • Knowledge of provider reimbursement methodologies preferred • Previous structured testing experience preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plan • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity