Senior Business Analyst

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