Senior Healthcare Business Analyst - Clinical Coding Specialist

Cynet Systems•Columbia, SC

About The Position

Our client is seeking an IT Healthcare Consultant - Business Analyst - Advanced (Clinical Analyst and Coding Specialist) to support the ongoing operations and policy requirements of the Medicaid Management Information System (MMIS). The successful candidate will act as a subject matter expert in medical coding and Medicaid policy, ensuring accurate CPT/HCPCS and ICD-10 code maintenance within the Reference Administration sub-system. This project is a multi-year effort primarily focused on providing consulting services to operations and policy staff for the current Medicaid Management Information System (MMIS). The candidate will serve as a subject matter expert (SME) to assist policy and process owners in making informed recommendations for Medicaid members and providers. The role requires building and sustaining a strong operational foundation by applying knowledge of CPT/HCPCS and ICD-10 coding within the Reference Administration sub-system.

Requirements

3+ years of experience in healthcare.
Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
3+ years of extensive knowledge in anatomy, physiology, pharmacology, and medical terminology.
3+ years of strong knowledge in formal business process documentation.
Current credentials as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
Strong verbal and written communication skills.
Ability to communicate effectively with executive management, line management, project management, and team members.

Nice To Haves

3+ years of experience in healthcare hospital, office, and clinic settings.
Proficiency with Microsoft Office (Word, Excel, PowerPoint) and medical coding software programs such as Optum Encoder.

Responsibilities

Assist with CPT/HCPCS and ICD-10 code maintenance.
Initiate annual and quarterly CMS updates for all ICD-10 and CPT/HCPCS coding changes.
Perform initial review of codes to determine the scope of changes.
Prepare lists of code changes for Reference Administration staff and Medicaid Program staff review and analysis.
Conduct meetings with agency personnel, stakeholders, and process owners.
Participate in replacement MMIS project meetings as needed where reference administration expertise is required.
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 central repository.
Collaborate with the team to ensure complete process documentation and routinely updated training content for owners and stakeholders.
May serve as a back-up for claim escalations research within the bureau after demonstrating full proficiency in primary job functions.
Perform other project-related duties as assigned.