Cms Audit Analyst Jobs (NOW HIRING)

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: This role is a Sr. BTA position focused on translating Medicare Advantage and Medicaid Risk Adjustment business requirements into production-ready technical solutions, including Encounter RA Prioritization and Encounter RA Chart Process support. The ideal candidate brings advanced SAS, SQL, Snowflake, healthcare data integration, data quality, regulatory compliance, and reusable documentation experience.

• Partners with business analysts, Risk Adjustment stakeholders, IT, and vendor teams to understand provided Medicare Advantage and Medicaid business requirements, translate them into technical specifications, and support process improvements through SAS solutions and future Snowflake capabilities.
• Analyzes provided requirements, procedures, and data needs to automate processing, improve existing business systems, and support production-ready SAS code for Encounter Risk Adjustment Prioritization and Encounter Risk Adjustment Chart Process workflows, with future Snowflake migration support.
• Creates multi-user, real-time, robust database solutions by integrating complex healthcare datasets, including claims, enrollment, provider, pharmacy, clinical records, and vendor chart data.
• Acts as a technical subject matter expert to convert provided business requirements into system analysis, technical design, advanced SAS/SQL programming, Snowflake modernization, and documentation of business applications/systems.
• Modernizes legacy SAS ETL workflows into scalable Snowflake architecture using Snowflake SQL, Snowpark Python, and automated pipeline orchestration concepts such as Tasks and Streams
• Implements validation, reconciliation, and data quality frameworks to support CMS audit standards, state Medicaid requirements, and compliant Risk Adjustment encounter submissions.
• Builds reusable SAS, SQL, and Snowflake data assets, modular code libraries, and technical documentation to reduce development time and support knowledge transfer across data and actuarial teams.
• Develops ad-hoc reports to conduct data analysis and validation.
• Confers with area/department to analyze current operational procedures and trends and identify problems.
• Conducts business analysis and recommends technical alternative solutions to management as to course of action that best meets the organization's goals.
• Research, evaluate and assess the financial impact of issues identified in data/processes.
• Analyzes requirements, procedures, and problems to automate processing or to improve existing business systems.
• Creates multiuser, real-time, robust database solutions.
• Acts as subject matter expert to provide business and technical expertise in requirements solicitation, system analysis, technical design, programming and documentation of business applications/systems.
• May be responsible for monitoring and reporting to management on the status of departmental projects: Anticipates and identifies issues that could inhibit achieving the project goals and objectives, and implementing corrective actions and mitigation strategies.
• Provides oversight and resolves complex issues, optimizing performance, resolving problems, and providing timely follow-up on identified issues.
• Provides guidance and training to staff on process, procedures and issue resolution.
• Complies with all policies and standards

Education/Experience:

Requires a Bachelor's Degree in a related field:

Required or equivalent work experience in technical data analysis, conducting system analysis meetings, developing system design documents, developing project plans with achievable milestones and deadlines, and mediating different department demands to gain approvals on system scope and design.

Preferred Experience:

• Master's degree in a related field, i.e., Mathematics, Computer Science, etc may be considered in lieu of some of the required experience (not to exceed 2 years)
• 1+ year of experience in Healthcare
• 4+ years of experience in relevant programming to include SAS, SQL, Snowflake
• Experience with Medicare Advantage, Medicaid, Risk Adjustment, encounter submissions, claims, enrollment, provider, pharmacy, clinical, and vendor chart data.
• Experience modernizing SAS ETL workflows into Snowflake using Snowflake SQL, Snowpark Python, and automated pipeline orchestration
• 3+ years of experience in related business analysis
• 1+ year of experience in ASP/ASP.NET

Licenses and Certifications :

A license in one of the following is preferred:

• Preferred SAS Certified Professional or SAS Certification.
• Preferred SnowPro Certification.

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.

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