IT Healthcare Consultant – Business Analyst (Clinical Analyst & Coding Specialist)

Cambay Healthcare LLC is seeking an experienced Healthcare Business Analyst/Clinical Coding Specialist to support Medicaid MMIS operations and healthcare process improvement initiatives. The role involves analyzing coding updates, researching healthcare business rules, and collaborating with stakeholders to enhance MMIS operations.

Responsibilities:

• Review and analyze CPT/HCPCS and ICD-10 coding updates
• Research healthcare business rules and Medicaid policies
• Work with stakeholders, policy owners, and IT teams
• Support MMIS enhancements and future MMIS replacement projects
• Maintain business requirements and process documentation
• Participate in coding analysis and medical necessity reviews

Requirements:

• 5+ years in healthcare insurance, medical review, program integrity, or appeals
• 5+ years of medical coding experience in payer environment
• 5+ years working with IT developers/programmers
• Strong ICD/CPT/HCPCS coding knowledge
• Clinical healthcare experience required
• Strong analytical, communication, and documentation skills
• BSN or ADN Degree
• Active South Carolina RN License
• CPC or CCS Certification required
• Knowledge of Microsoft Office Suite
• Candidate must currently reside in South Carolina
• Claims processing systems
• Policy remediation
• Optum Encoder or other coding software