Please note that this position is with our direct client "

We are looking Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst (Min 3+yrs Exp) REMOTE (Web Cam Interview)

DIRECT CLIENT Position

Number of positions: 1

Length: 12Months +

Work Address: Columbia, SC 29210

looking for an IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst

Work Location: 80% remote, resources will need to come onsite in Columbia, SC to certain trainings/meetings

Candidate Location: Resource can reside anywhere in the US - must be willing to travel onsite to Columbia, SC within notice from management at the resources expense. Strong preference for resources that are local to SC, NC, or GA.

SCOPE OF THE PROJECT:

This project is a multi-year-old 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. It is necessary to build and

sustain a strong staff who understands coding, aids staff in understanding CPT/HCPCS and

ICD-10 coding and apply the codes correctly within the Reference Administration sub-system.

POSITION: IT Healthcare Consultant Business Analyst -Advance

OBJECTIVES TO BE FULFILLED BY CANDIDATE:

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

REQUIRED CERTIFICATIONS:

Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified

Coding Specialist)

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

Required/Desired Skills

Candidates must have ALL the "Required" skills in order to be considered for the position. "Desired" or "Highly Desired" skills are a PLUS but may NOT be required.

Skill Matrix

Experience with Business workflow processes

Required / Desired

Amount of Experience

Years of Experience

Bachelor's degree in healthcare related field.

Required

Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).

Required

3+ years' experience in healthcare

Required

Years

Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies

Required

3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology

Preferred

Years

3+ years of strong knowledge of formal business process documentation

Required

Years

3+ years' experience healthcare hospital, office and clinic setting

Preferred

Years

Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)

Preferred

Resource is local to South Carolina, North Carolina, or Georgia

Preferred

Business Analyst -Clinical Analyst with Min 5yrs exp (Webcam Interview)(REMOTE_Anywhere in USA)

Key skills

About this role