Business Analyst

Novalink Solutions LLC•West Columbia, SC

5d•Hybrid

About The Position

The South Carolina Department of Health & Human Services (SCDHHS) is the State Medicaid Agency for South Carolina. 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. Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive. The workload and complexities of the reference administration responsibilities require additional support to maintain efficiency and to achieve defined deliverable dates. The additional position will allow us to finalize succession planning for the Reference Administration team. 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.

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
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
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.
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
Strong collaboration and relationship building skills.
Experience in healthcare or degree to align with healthcare environment

Nice To Haves

Clinical background – not required but could be beneficial
Candidates with hospital, office, or clinic settings experience will be beneficial.
3+ years’ experience healthcare hospital, office and clinic setting
Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
Resource is local to South Carolina, North Carolina, or Georgia
Willing to travel onsite to Columbia, SC within notice from management at the resources expense.

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