Medicaid IT Business Analyst #26-10021

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. The Medicaid IT Business Analyst will support medical code change requests and participate in process improvements, while providing subject matter expertise in Medicaid Management Information Systems.

Responsibilities:

• Collaborates with internal recipient and owner of initial review of codes to determine scope of changes for planning and timely completion
• Receives listings of codes changes distributed to the Reference Administration and Medicaid Program staff for review and analysis
• Serves as an approver within the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes
• Serves as lead for meetings with Agency personnel, stakeholders, and process owners
• Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics
• Researches business rules, requirements, and models to complete initial analysis and recommendations
• Maintains business rules, requirements, and models in a repository
• Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated
• Participates in agency projects and related initiatives requiring subject matter expertise
• Other duties, as assigned or required

Requirements:

• 5 years' experience in healthcare insurance; medical review, program integrity, or appeals
• 5 years' experience working with IT developers/programmers in a payor environment
• 5 years' experience Medical Coding in payer environment
• 3 years' clinical experience in a healthcare environment (Strong clinical assessment and critical thinking skills.)
• 5 years' strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
• Bachelor's degree in Health Information, Healthcare Administration, or related field; equivalent experience may be considered with a minimum of 3+ years of direct supervisor experience
• Superb written and oral communications skills, strong proficiency in English
• Strong knowledge of formal business process documentation
• Ability to effectively communicate with executive management, line management, project management, and team members
• 5 years' experience in policy remediation
• 5 years' Medical Claim processing systems experience
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs)