Position Purpose: Serve as a senior operational and analytical partner for assigned National Provider organizations. This remote role owns provider-facing coordination, roster reconciliation, provider data integrity, issue resolution, and cross-functional execution across national provider portfolios. Business Analyst IV translates complex provider, claims, contract, and operational data into actionable recommendations that improve configuration accuracy, reduce provider abrasion, strengthen the provider experience, and support timely, accurate claims payment.
Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
Remote nation-wide available for this opportunity.
- 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.
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.
By applying to this requisition, you acknowledge and understand that you may be considered for other job opportunities for which Centene believes you may be qualified.
Pay Range: $87,700.00 - $157,800.00 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
