IT Healthcare Consultant Clinical Analyst & Coding Specialist for Hybrid
Columbia, SC, US • Posted 1 day ago • Updated 3 hours ago
Syntricate
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Job Details
Skills
- ICD
- CPT
- HCPCS
- MEDICAL
- BSN
- ADN
- ASSOCIATE DEGREE IN NURSING
- BACHELOR OF SCIENCE IN NURSING
Summary
Duration of the Contract: 12 months
Possibility for Extension: Yes
Work Location: Hybrid (20% onsite - must be available to come onsite periodically)
Description:
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 review patient records against established criteria to determine medical necessity.
- Other project-related duties.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
- 5+ years in healthcare insurance; medical review, program integrity, or appeals.
- 5+ years working with IT developers/programmers in a payor environment.
- 5+ years Medical Coding in payer environment.
- 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
- 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
- 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.
ADDITIONAL SKILLS:
- 5+ years written and oral communications skills, strong proficiency in English.
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
- 5+ years’ experience in policy remediation.
- 5+ years claims processing systems experience.
- 5+ years knowledge of Microsoft Office
- 5+ years Optum Encoder and/or other medical coding software programs
REQUIRED EDUCATION:
- Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
REQUIRED CERTIFICATIONS:
- Must have current, active, and non-restricted licensure by the client Board of Nursing as a Registered Nurse.
- Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.
- Dice Id: 91142014
- Position Id: 26-00554
- Posted 1 day ago
Company Info
About Syntricate
We are here to analyze and resolve the most intricate processes and deliver market’s best solution and services to your business problems.
Syntricate Technologies is an Information Technology and Business Consulting company that offers comprehensive solutions to our clients for Quality Assurance, Validation, Regulatory, Business Analysis and Project Management services. Our core values are integrity, delivering value and making positive impact on society. We are committed to our client success and work on high standards to provide the best professional services.
We believe in effective integration of technology to improve business processes. We provide solutions that address the current and long-tern needs of our clients nationwide which range from various industries such as Healthcare, Pharmaceutical, Life Sciences, Finance and Insurance.
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