CARC, RARC Business Analyst III

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.
 

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.  

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

• Manage the ticketing process across all claim platforms specific to creating new, or modifying current, claim explanation codes and connecting the correct CARC & RARC codes.
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems.
• Identify and analyze user requirements, procedures, and problems to improve existing processes.
• Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations.
• Identify ways to enhance performance management and operational reports related to new business implementation processes.
• 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.
• Diagnose problems and identify opportunities for process redesign and improvement.
• Formulate and update departmental policies and procedures.
• Serve as the subject matter expert on the assigned function product to ensure operational performance.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:
Bachelor’s degree in related field or equivalent experience. 4-6 years of business process or data analysis experience, preferably in healthcare. Project management experience preferred. Prior experience with creating/maintaining claim explanation codes is preferred. Prior experience with CARC (Claim Adjustment Reason Codes), RARC (Remittance Advice Remark Codes), and CAQH (The Council for Affordable Quality Healthcare) is highly preferred.

Pay Range: $68,700.00 - $123,700.00 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