IT - SCDHHS - IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst

The South Carolina Department of Health & Human Services is the state Medicaid agency for South Carolina. The IT Healthcare Consultant – Business Analyst – Advanced will support medical code change requests, provide recommendations to policy and process stakeholders, and serve as a subject matter expert for medical coding, Medicaid policy, and related MMIS initiatives. The role will also contribute to process improvements, documentation, training, and code maintenance.

Responsibilities:

• 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

Requirements:

• 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
• Bachelor's degree in healthcare related field. An equivalent combination of experience and education may be considered with prior SCDHHS hiring team review and approval
• Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist)
• strong analytical skills
• Managing multiple work efforts simultaneously
• Medical Coding
• Time management skills
• CPT/HCPCS and ICD-10 translation knowledge and ability to learn how medical codes link to claims processing
• Ability to understand business and functional requirements
• The candidate must have strong collaboration and relationship building skills
• Experience in healthcare or degree to align with healthcare environment
• Written and oral communications skills, strong proficiency in English
• Ability to effectively communicate with executive management, line management, project management, and team members
• 3+ years' experience healthcare hospital, office and clinic setting
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
• Clinical background – not required but could be beneficial
• Candidates with hospital, office, or clinic settings experience will be beneficial
• Strong preference for resources that are local to SC, NC, or GA
• preference for resources that are local to SC, NC, or GA