Centene CorporationRemote
Coding Business Analyst II - Content Updates
United States of America
Full Time
8 hours ago
$56,000 - $101,000 USD
No H1B
Key skills
Claims codingCoding certification - CPC or similarClaims coding appealsClaims auditingClaims researchExcel - pivot tablesExcel - VLOOKUPBusiness process analysisManaged care information systemsProvider reimbursement methodologiesUser acceptance testingCommunicationProblem Solving
About this role
Centene Corporation is transforming the health of communities, and they are seeking a Coding Business Analyst II to perform various analyses linking business needs and objectives. The role involves ensuring compliance in claims coding, developing payment policies, and supporting business initiatives through data analysis.
Responsibilities:
- Ensuring our internal claims coding editors remain accurate, up to date, and compliant
- Review, analyze, and interpret coding, reimbursement, and regulatory guidelines to ensure organizational compliance and payment integrity
- Develop, implement, and maintain Payment Policies, reimbursement methodologies, and claims editing logic to support accurate claims adjudication
- Monitor, report on, and track regulatory, coding, and policy updates, ensuring timely implementation and communication of changes across impacted stakeholders
- 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:
- 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
- Knowledge of provider reimbursement methodologies
- Previous structured testing experience
- Coding certification such as a CPC or similar
- Claims coding appeals and auditing experience
- Claims research experience
- Excel skills with pivot tables and VLOOKUPs