MMIS Business analyst

We are looking for a highly skilled MMIS Business analyst to join a fast-paced team focused on critical Medicaid policy and system improvements.

If you are a problem-solver who enjoys bridging the gap between healthcare policy and technical implementation, this role is for you.

Logistics & Details

• Work Arrangement: Fully Remote.
• Location Requirement: Must be a South Carolina resident. (No relocation allowed).
• Interview Process: 1-round, Virtual/Online.
• Preferred Skills: Experience in policy remediation, medical claims processing systems, and Optum Encoder.

The Position

You will serve as a Subject Matter Expert (SME), translating complex federal medical coding requirements (ICD-10, CPT/HCPCS) into functional business rules. You will collaborate with IT developers to ensure the Medicaid Management Information System (MMIS) reflects accurate policy changes for seamless claims adjudication.

Core Qualifications

• Healthcare Expertise: 5+ years in healthcare insurance (program integrity, appeals, or medical review).
• Coding Mastery: 5+ years of Medical Coding experience specifically in a payer environment.
• Technical Collaboration: 5+ years working directly with IT developers/programmers to translate requirements.
• Clinical Background: 3+ years of clinical experience (demonstrating strong assessment/critical thinking skills).
• Coding Knowledge: Deep proficiency in ICD/CPT/HCPCS translation and methodologies.