Business Analyst – Consultant (Reference Administration)

InterSources Inc is seeking a Business Analyst – Consultant specializing in Reference Administration. The role involves supporting the medical code change lifecycle, collaborating with stakeholders, and ensuring accurate claims adjudication outcomes.

Responsibilities:

• Support medical code change lifecycle including analysis, validation, and implementation
• Research and document business rules, requirements, and process workflows
• Collaborate with policy owners, stakeholders, and IT teams for approvals and updates
• Act as SME for ICD-10, CPT, and HCPCS coding methodologies
• Analyze and resolve complex MMIS-related issues
• Participate in MMIS enhancements and process improvement initiatives
• Facilitate stakeholder meetings and communicate across technical and non-technical teams
• Maintain documentation repository for business requirements and coding changes
• Ensure updates result in accurate claims adjudication outcomes
• Support training documentation and knowledge transfer activities

Requirements:

• Bachelor's degree in Health Information, Healthcare Administration, or related field
• OR equivalent experience with 3+ years of supervisory experience
• 5+ years in healthcare insurance (medical review, program integrity, or appeals)
• 5+ years working with IT developers/programmers in a payer environment
• 5+ years of medical coding experience (payer side)
• 3+ years clinical experience in a healthcare setting
• Strong knowledge of ICD-10, CPT, HCPCS coding and translation methodologies
• Experience with business analysis, requirements gathering, and documentation
• Strong analytical, problem-solving, and communication skills
• Ability to manage multiple priorities and deadlines
• 5+ years experience in policy remediation
• Experience with medical claims processing systems
• Familiarity with tools such as: Microsoft Office (Excel, Word, PowerPoint)
• Optum Encoder or other coding tools