Ventures Unlimited Inc is seeking a Senior Business Analyst to support healthcare coding and policy initiatives. The role involves analyzing coding changes, collaborating with stakeholders, and leading meetings to provide guidance on coding methodologies.
Responsibilities:
- Support CPT/HCPCS and ICD-10 code maintenance and updates
- Analyze coding changes related to Medicaid policy and agency initiatives
- Work closely with business owners, stakeholders, and IT development teams
- Lead meetings with agency personnel and provide SME guidance on coding methodologies
- Research business rules, requirements, and claims adjudication outcomes
- Maintain documentation repositories for requirements, business rules, and processes
- Assist in training documentation and ongoing process improvements
- Participate in agency projects requiring healthcare and coding expertise
Requirements:
- Must be a South Carolina resident (No relocation allowed)
- 5+ years of healthcare insurance experience (medical review, appeals, program integrity, etc.)
- 5+ years working with IT developers/programmers in a payer environment
- 5+ years of medical coding experience in payer environment
- Strong experience with ICD/CPT/HCPCS translation and coding methodologies
- Experience with Medicaid policy, claims processing systems, and MMIS
- Strong analytical, communication, and stakeholder management skills
- Ability to manage multiple priorities simultaneously
- Bachelor's degree in health information, Healthcare Administration, or related field. Equivalent experience may be considered
- Experience in policy remediation
- Medical claims processing systems expertise
- Experience with Microsoft Office Suite and coding tools such as Optum Encoder