Title - IT Healthcare Consultant - Business Analyst
Location - Columbia , SC - 29201 -Hybrid -80% Remote
The Business Analyst will support the medical code change requests by researching and making recommendations to policy and process owners and stakeholders for review and approval. The position will also participate as a project team member, as assigned, for related process improvements, Medicaid Management Information System (MMIS) enhancements and provide subject matter expertise for a future MMIS replacement. The position we are seeking to fill is for a candidate with a background in healthcare and is a Certified Medical Coder.
The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. As the IT Healthcare Consultant Business Analyst Advanced (Clinical Analyst and Coding Specialist):
Specific duties include, but are not limited to:
Initiates annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
Performs initial review of codes to determine scope of changes.
Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis.
Conducts meetings with Agency personnel, stakeholders, and process owners.
(Future) Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
Research 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.
May serve as a back-up to other roles within the bureau to support claim escalations research, once the person has demonstrated full proficiency in the job functions required for their new role
Other project-related duties, as assigned or required
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
3+ years experience in healthcare
Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
3+ years of strong knowledge of formal business process documentation
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
3+ years experience healthcare hospital, office and clinic setting
Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
Other: preference for resources that are local to SC, NC, or GA. Resources can reside anywhere in the US but must be willing to travel onsite to Columbia, SC within notice from management at the resources expense.
REQUIRED EDUCATION:
Bachelor s degree in healthcare related field. An equivalent combination of experience and education may be considered with prior hiring team review and approval.
REQUIRED CERTIFICATIONS:
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
The interviews will be conducted by a team either in-person or via video conferencing.
ADDITIONAL SKILLS / Notes:
Written and oral communications skills, strong proficiency in English
Ability to effectively communicate with executive management, line management, project management, and team members
