Project Overview
This is a long-running, multi-year effort that provides consulting services to operations and policy staff for the current MMIS. The focus of this role is to serve as a subject matter expert (SME), building knowledge that helps policy and process owners make the best recommendations for Medicaid members and providers. You will help staff understand CPT/HCPCS and ICD-10 coding and apply codes correctly within the Reference Administration sub-system.
Key Responsibilities
Initiate annual and quarterly updates from CMS for all ICD-10 and CPT/HCPCS coding changes.
Perform initial code reviews to determine the scope of changes.
Prepare listings of code changes for Reference Administration and Medicaid Program staff to review and analyze.
Conduct meetings with agency personnel, stakeholders, and process owners.
Participate in replacement MMIS project meetings where reference administration expertise is needed.
Serve as an 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 repository.
Collaborate with the team to keep process documentation and stakeholder training content complete and up to date.
Once fully proficient, serve as back-up for other roles in the bureau, including claim escalation research.
Perform other project-related duties as assigned.
Required Skills
3+ years of experience in healthcare.
Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
3+ years of extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.
3+ years of strong knowledge of formal business process documentation.
Strong analytical skills and the ability to manage multiple work efforts at the same time.
Ability to learn how medical codes link to claims processing.
Ability to understand business and functional requirements.
Strong time management, collaboration, and relationship-building skills.
Excellent written and oral communication skills, with strong proficiency in English.
Ability to communicate effectively with executive management, line management, project management, and team members.
Preferred Skills
3+ years of healthcare experience in hospital, office, or clinic settings.
Proficiency with Microsoft Office (Word, Excel, PowerPoint), Optum Encoder, and other medical coding software.
A clinical background is helpful but not required.
Residence in SC, NC, or GA.
Education
Bachelor's degree in a healthcare-related field.
An equivalent combination of education and experience may be considered, subject to the Client's hiring team review and approval.
Required Certification
Current credential as a CPC (Certified Professional Coder) or CCS (Certified Coding Specialist).
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