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.
 

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

• Lead the support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
• Lead the identification and analysis of user requirements, procedures, and problems to improve existing processes
• Resolve issues and identify opportunities for process redesign and improvement
• Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements
• Evaluate risks and concerns and communicate to management
• Coordinate with various business units and departments in the development and delivery of training programs
• Develop, share, and incorporate organizational best practices into business applications
• Oversee all changes to departmental policies and procedures, including communicating and implementing the changes
• Serve as the subject matter expert on the assigned function product to ensure operational performance
• Ability to travel

Education/Experience: Bachelor’s degree in related field or equivalent experience. 6+ years of business process or data analysis preferably in healthcare or 5+ years of HEDIS analysis. Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Project management experience preferred.

Benefits and Payment Configuration: Bachelor’s degree in related field or equivalent experience. 6+ years of business process analysis, preferably in healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis experience. Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Experience in benefits, pricing, contracting or claims and knowledge of provider reimbursement methodologies. Knowledge of managed care information or claims payment systems preferred. Previous structured testing experience preferred.

Compliance Coding/Prepay Compliance (Payment Integrity): Bachelor’s degree in related field or equivalent experience. 6+ years of business process analysis (i.e. documenting business process, gathering requirements). Experience in healthcare industry, preferably with managed care techniques and administrative philosophy. Experience in claims coding analysis or medical claim review/research preferred. Knowledge of Amisys claims payment system and Business Objects preferred.

Encounters: Bachelor’s degree in related field or equivalent experience. 6+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry or 5+ years of managed care encounters experience. Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Experience with encounters or claims business analysis experience in healthcare, preferably managed care or Medicaid. Knowledge of Amisys or other claims system, HIPAA transactions (i.e. 837, 999, 824, 277) and SQL Scripting preferred.

Provider Data: Bachelor’s degree in related field or equivalent experience. 6+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry and/or working in a data driven environment. Advanced knowledge of Microsoft Applications, including Excel, Project, and Visio preferred. Knowledge of data migration, software enhancement/planning, and Agile required. Experience managing large projects with a high reliance on technology. Product Management and SQL experience preferred.

Member & Provider Solutions: Bachelor’s degree in related field or equivalent experience. 6+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry and/or customer service or enrollment functions. Advanced knowledge of Microsoft Applications, including Excel and Visio preferred. Experience managing projects with a high reliance on technology. Knowledge of data integration, software enhancements/planning and Agile preferred.

Risk Adjustment: Bachelor’s degree in related field or equivalent experience. 6+ years of business process or data analysis experience, including business process definition and documentation and agile development, preferably in healthcare working in a data driven environment. Advanced knowledge of Microsoft Applications, including Excel, Access and Visio preferred. Experience managing large projects with a high reliance on technology. Project management experience preferred. Experience in claims and knowledge of risk adjusted revenue, member quality and provider reimbursement methodologies preferred.
Knowledge of managed care information or claims payment systems preferred. Previous structured testing experience preferred. Product Management and SQL experience preferred.

Enterprise PHCO Utilization Management: Bachelor’s degree in related field or equivalent experience. 6+ years of business process analysis, deep understanding of managed care/utilization management data including sourcing, analysis and representation of data, understanding of and experience in clinical documentation platforms. Advanced knowledge of Microsoft Applications, including Excel and PowerPoint.”

Pay Range: $84,300.00 - $151,700.00 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