IT Healthcare Consultant - Business Analyst (Clinical Analyst and Coding Specialist) (Hybrid)

Serigor•Columbia, SC

5d•Hybrid

About The Position

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. 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. Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive.

Requirements

Bachelor's degree in healthcare related field. An equivalent combination of experience and education may be considered with prior hiring team review and approval.
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
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.
Written and oral communications skills, strong proficiency in English.
Ability to effectively communicate with executive management, line management, project management, and team members.

Nice To Haves

3+ year experience healthcare hospital, office and clinic setting.
Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs).

Responsibilities

Assists with the CPT/HCPCS and ICD-10 code maintenance.
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.
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.