Note: The job is a remote job and is open to candidates in USA. Centene Corporation is seeking a Business Analyst IV to serve as a senior operational and analytical partner for assigned National Provider organizations. The role leads provider-facing coordination, roster reconciliation, provider data integrity, issue resolution, business process improvement, and cross-functional execution to support accurate configuration and timely claims payment.
Responsibilities
- 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
- Own the day-to-day operational relationship for assigned National Provider groups, delivering responsive, professional, and solutions-oriented service
- Plan and lead provider-facing and internal meetings; develop clear agendas, executive-ready presentations, status updates, decision logs, and follow-up actions
- Maintain complete, organized records for assigned provider portfolios, including rosters, contracts and amendments, reconciliation findings, submissions, issues, decisions, and resolution status
- Perform complex provider roster reconciliations and data-quality reviews across CenProv, Portico, PIX, Xcelys, Amisys, and related reporting tools to identify enrollment, affiliation, demographic, credentialing, network, and configuration discrepancies
- Validate provider data elements, including TIN, NPI, network and line of business, effective dates, locations, affiliations, credentialing cycles, and directory indicators; coordinate corrective submissions and confirm resolution
- Perform other duties as assigned and comply with all policies and standards
Skills
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
- Remote nation-wide available for this opportunity
- 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
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- A flexible approach to work with remote, hybrid, field or office work schedules
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