Centene Corporation Project Lead Business Systems Analyst - Business Intelligence in St. Louis, Missouri

Professional

This position is responsible for the design, build & testing of the compliance reporting solutions. The Project Lead Business System Analyst – Compliance Reporting will lead the compliance reporting requirements for the delivery of Medicaid, Medicare, MMP & Marketplace specific federal and state CMS compliance reports and data extracts. Strong partnership skills are critical in this role as the delivery of these reports is done in partnership with other business and application teams. These reports are requested by compliance leaders at health plans, corporate compliance and regulatory operations and are required for submission to state & federal CMS agencies. The compliance reporting suite encompasses reports across Claims, Prior Authorizations, Provider, Member, Appeals & Grievances (A&G), Cost Avoidance & Recovery, Call Center & Medical Management, Coverage determination A&G, Organization determinations A&G & Special needs Plan – Model of care.

Key Functions and Responsibilities:

  • Responsible for the entire implementation process.

  • Drive definition of business need, responsible for overall solution design, build and test, root cause analysis for complex business processes and functionality.

  • Responsible for identifying the need, defining and implementing improvements in the methods, standards and processes to better enable working in teams and constructing enterprise applications

  • Consult with users to identify current operating procedures and to clarify program objectives

Education/Experience: Bachelor's degree in Computer Science, MIS, related field or equivalent experience. 5+ years of related experience and 1-2 years of business solutions experience with high complexity, multiple large application business processes.

Preferred:

  • Experience/exposure developing business requirements for Health care solutions like Claims, Prior Authorizations, Provider, Member, Appeals & Grievances (A&G), Cost Avoidance & Recovery, Call Center & Medical Management, Coverage determination (A&G), Organization determinations (A&G), Special needs Plan – Model of care

  • Experience/exposure to facilitating business process design as it relates to State or Federal CMS reporting

  • Ability to present project solutions to clients, manage client expectations, and work with implementation team to deliver solutions.

  • Heavy Project Management experience

  • Background in SDLC

  • Experienced with Data Mapping Source to Target and ability to identify root cause of Data inconsistencies

  • Knowledge of programming languages (SQL), project management, and application or systems development methodologies, RFP, contracting and new business implementation

  • Database experience (Teradata, Hadoop, Oracle, SQL*Server).

  • Requires either healthcare data/systems/process experience, exposure to dimensional data modeling/data warehousing experience

  • Experienced working with AGILE methodologies, utilizing JIRA

  • Ability to work collaboratively with both internal and partners in defining sustainable customer solutions

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.

TITLE: Project Lead Business Systems Analyst - Business Intelligence

LOCATION: St. Louis, Missouri

REQNUMBER: 1102727

COMPANY: Information Technology

POSITION TYPE: Professional