Business Analyst IV
Woodland Hills, CA

Job Description

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.

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.