IT Healthcare Consultant – Business Analyst - Advanced (Clinical Analyst & Coding Specialist

InterSources Inc is a Small, Woman, and Minority-Owned Business Enterprise specializing in IT Consulting Services. They are seeking an IT Healthcare Consultant to manage coding updates, analyze changes, and collaborate with teams to enhance documentation and training materials.

Responsibilities:

• Initiate annual and quarterly ICD-10, CPT, and HCPCS coding updates from CMS
• Review and analyze coding changes to determine business and operational impacts
• Prepare code change listings for Reference Administration and Medicaid Program teams
• Conduct meetings with agency personnel, stakeholders, and process owners
• Serve as SME for medical coding methodologies and Medicaid policy
• Research business rules, requirements, and models to provide recommendations
• Maintain business rules and documentation repositories
• Collaborate with teams to ensure documentation and training materials are updated
• Participate in MMIS enhancement and future replacement initiatives
• Support medical necessity reviews when required
• Assist with process improvement initiatives and project-related activities

Requirements:

• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
• Active, unrestricted South Carolina Registered Nurse (RN) license
• CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification
• ICD-10 proficiency certification or ability to obtain within one year
• 5+ years healthcare insurance experience (medical review, appeals, or program integrity)
• 5+ years working with IT developers/programmers in a payer environment
• 5+ years medical coding experience in payer environment
• 3+ years clinical healthcare experience with strong assessment skills
• 5+ years knowledge of ICD/CPT/HCPCS coding methodologies
• Strong understanding of anatomy, physiology, pharmacology, and medical terminology
• Strong analytical, communication, collaboration, and relationship-building skills
• Experience managing multiple work efforts simultaneously
• Ability to write and understand business and functional requirements
• 5+ years policy remediation experience
• 5+ years claims processing systems experience
• Experience with Optum Encoder and other medical coding software programs
• Government operations and managed care background preferred