Business Analyst
Refulgent Technologies Inc.
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Job Details
Skills
- healthcare insurance; medical review
- program integrity
- payorenvironment.
- Medical Coding
- ICD/CPT/HCPCS
- Payer
Summary
Job: Business Analyst
Location: remote ( Must be SC Resident, No relocation)
Specific duties include, but are not limited to:
Collaborates with internal recipient and owner of initial review of codes to determine
scope of changes for planning and timely completion.
Receives listings of codes changes distributed to the Reference Administration and
Medicaid Program staff for review and analysis.
Serves as an approver within the code change / update process following the internal
initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding
changes.
Serves as lead for meetings with Agency personnel, stakeholders, and process
owners.
Serves as an agency subject matter expert (SME) for medical coding methodologies,
Medicaid policy, and related topics.
Researches 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.
Participates in agency projects and related initiatives requiring subject matter
expertise.
Other duties, as assigned or required.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
5 years experience in healthcare insurance; medical review, program integrity, or appeals.
5 years experience working with IT developers/programmers in a payor
environment.
5 years experience Medical Coding in payer environment.
3 years clinical experience in a healthcare environment (Strong clinical assessment and critical thinking skills.)
5 years strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
- Dice Id: 10379129
- Position Id: 10851
- Posted 45 minutes ago
Company Info
About Refulgent Technologies Inc.
Founded in 2005 and headquartered in Charlotte, North Carolina, Refulgent Technologies Inc. is a trusted provider of IT staffing, consulting, and software development solutions. For nearly two decades, we’ve partnered with businesses across industries to deliver the right people, processes, and technologies that drive digital transformation.
Our Mission – To help our clients plan, design and deploy projects that provide unparalleled technical competitiveness, cost effectiveness, and long-term ROI.
Our Services
• IT Staffing & Contract Workforce Solutions
• Custom Software Development (Web, Mobile, Enterprise)
• Application Maintenance & QA Testing
• Project Management & IT Consulting
Industries We Serve
• Public Sector / Government
• Banking & Financial Services
• Insurance
• Retail & Manufacturing
• Energy & Utilities
• Healthcare
• Automotive & Technology
What Sets Us Apart
• Nearly 20 years of proven expertise.
• Hybrid delivery model: onsite, offsite, and offshore for flexibility and cost savings.
• Commitment to accountability, innovation, and client satisfaction.
• Strong track record of building long-term client and contractor partnerships.
Contract Staffing Needs
Project Management Professional (PMP Certified)
Architect - Enterprise, System, Application
Software Developer - .Net, Java, Power Automate, Salesforce
Data – Architect, Engineer, Administrator, Business Intelligence, Analytics
Cloud - Architect, Engineer (Azure, AWS)
Network – Architect, Engineer
Cyber Security - Architect, Engineer
IT Support – Desktop, Server Administrator
GIS (ArcGIS, ESRI)
UI/UX Designer, Developer
Scrum Master, Product Manager, Product Owner, Business System Analyst
Software Quality Analyst
AI/ML Engineer
Healthcare Specialist
Get in Touch
Discover how Refulgent Technologies Inc. can support your staffing and technology needs.
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