Healthcare Coding & Clinical Business Analyst - HYBRID (W2 ONLY)

Job Description:

***Only W2 resumes are accepted

Work Location: 80% remote, resources will need to come onsite in Columbia, SC to certain trainings/meetings

Candidate Location: Resource can reside anywhere in the US - must be willing to travel onsite to Columbia, SC within notice from management at the
resources expense. Strong preference for resources that are local to SC, NC, or GA

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.

DAILY DUTIES / RESPONSIBILITIES:

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 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

Required Skills

·       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

·       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.

·       Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). 

Preferred Skills

·       3+ years’ experience healthcare hospital, office and clinic setting

·       Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)

·       Other: preference for resources that are local to SC, NC, or GA. Resources can reside anywhere in the US – but must be willing to travel onsite to Columbia, SC within notice from management at the resources expense.

Additional skills & duties: 

·       Written and oral communications skills, strong proficiency in English

Ability to effectively communicate with executive management, line management, project management, and team members