IT Healthcare - Business Analyst (Clinical Analyst & Coding Specialist)

Role: IT Healthcare - Business Analyst (Clinical Analyst & Coding Specialist)

Location: Columbia, SC (Remote)

Duration: 12+ months

Candidate Location: Candidate MUST be a SC resident. No relocation allowed.

Job Description:

SCOPE OF THE PROJECT:

This project is a multi-year effort which primarily focuses on providing consulting services to operations and policy staff for the current Medicaid Management Information System (MMIS). The current position s focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers.

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):

• 5+ years in healthcare insurance; medical review, program integrity, or appeals.
• 5+ years working with IT developers/programmers in a payor environment.
• 5+ years Medical Coding in payer environment.
• 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
• 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
• 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):

• 5+ years experience in policy remediation.
• 5+ years claims processing systems experience.
• 5+ years Optum Encoder and/or other medical coding software programs.

REQUIRED EDUCATION:

• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN).

REQUIRED CERTIFICATIONS:

• Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse. Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.