Business Analyst - Consultant

Novalink Solutions LLC•Islandton, SC

17h

About The Position

The Business Analyst Consultant will support medical code change requests by researching processes for policy and process owners and stakeholders for review and approval and supporting the updates. 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 roadmap and technology needs. The candidate will investigate, define and resolve complex MMIS issues, maintain a thorough knowledge of MMIS procedure code and associated pricing, provider/member relations and industry standards. The role requires understanding and practicing high customer service standards, communicating complex information to both technical and non-technical audiences, and facilitating collaboration between stakeholders. This role will also supervise staff responsible for MMIS updates, establish milestones, assign staff tasks and responsibilities, and analyze, design, plan, execute, and evaluate agency priorities and initiatives. This position is open due to increased workload and complexities in reference administration responsibilities requiring additional support to maintain efficiency and achieve defined deliverable dates. Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive. The project scope is an immediate support need focusing on providing consulting services to operations and policy staff for current medical coding federal requirements, quarterly and intermittently, and all coding changes associated with agency initiatives to ensure compliance policy and code change alignment. The Medicaid Management Information System (MMIS) is the system of record. The current position’s focus and priority is the continued support of serving as a subject matter expert (SME), utilizing knowledge of medical coding and MMIS to support change requests while ensuring change requests and system updates result in the expected claims adjudication outcomes for the benefit of Medicaid members and providers. Pre-employment checks include State mandatory Criminal, Credit and E-Verify background checks.

Requirements

Strong analytical skills
Experience managing multiple work efforts simultaneously
Medical Coding experience
Time management skills
CPT/HCPCS and ICD-10 translation experience
Ability to write and understand business and functional requirements
Knowledge of Medicaid Policy, coding changes, system functionality and successful implementation of changes for the expected outcome
Strong collaboration and relationship building skills
Experience in healthcare insurance
5+ years’ experience in healthcare insurance; medical review, program integrity, or appeals.
5+ years’ experience working with IT developers/programmers in a payor environment.
5+ years’ experience Medical Coding in payer environment.
3+ years clinical experience in a healthcare environment (Strong clinical assessment and critical thinking skills.)
5+ years’ strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
Superb written and oral communications skills, strong proficiency in English.
Strong knowledge of formal business process documentation.
Ability to effectively communicate with executive management, line management, project management, and team members.

Nice To Haves

5 years’ experience in policy remediation.
5 years’ Medical Claim processing systems experience.
Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs).

Responsibilities

Support medical code change requests by researching processes for policy and process owners and stakeholders for review and approval and supporting the updates.
Participate as a project team member for related process improvements, MMIS enhancements, and provide subject matter expertise for a future roadmap and technology needs.
Investigate, define and resolve complex MMIS issues.
Maintain a thorough knowledge and understanding of MMIS procedure code and associated pricing, provider/member relations and industry standards.
Understand, foster, and practice high customer service standards.
Communicate complex information to both technical and non-technical audiences.
Facilitate collaboration between stakeholders.
Supervise staff responsible for MMIS updates.
Establish milestones and assign staff tasks and responsibilities.
Analyze, design, plan, execute, and evaluate agency priorities and initiatives.
Assist with the CPT/HCPCS and ICD-10 code maintenance.
Collaborate with internal recipient and owner of initial review of codes to determine scope of changes for planning and timely completion.
Receive listings of codes changes distributed to the Reference Administration and Medicaid Program staff for review and analysis.
Serve as an approver within the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
Serve as lead for meetings with Agency personnel, stakeholders, and process owners.
Serve 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.
Maintain business rules, requirements, and models in a repository.
Collaborate with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
Participate in agency projects and related initiatives requiring subject matter expertise.
Other duties, as assigned or required.