Medical Coding/Payer Analyst (Remote - Must be local to SC)

The following are required for bid submission:

• Resume
• R2R
• Cover Letter
• Meets Work Location

Position Description

• The State of South Carolina is looking for a Business Analyst - Consultant (Reference Administration Business Analyst - Consultant)
• Why is this position open: New Position - The Business Analyst Consultant will support the medical code change requests by researching processes for policy and process owners and stakeholders for review and approval and supporting the updates.

Required Skills

• Education - Bachelor’s degree in Health Information, Healthcare Administration, or related field; equivalent experience may be considered with a minimum of 3+ years of direct supervisor experience.
• 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.

Preferred Skills

• 5+ years' experience in policy remediation.
• 5+ years' Medical Claim processing systems experience.
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs).

Company / Department culture:

• The South Carolina Department of Health & Human Services (SCDHHS) is the State Medicaid Agency for South Carolina. The Business Analyst Consultant will support the medical code change requests by researching processes for policy and process owners and stakeholders for review and approval and supporting the updates. The position will also participate as a project team member, as assigned, for related process improvements, Medicaid Management Information System (MMIS) enhancements and provide subject matter expertise for a future roadmap and technology needs. 
• Investigate, define and resolve complex Medicaid Management Information System (MMIS) issues.  Maintain a thorough knowledge and understanding of MMIS procedure code and associated pricing, provider/member relations and industry standards. Understand, foster, and practice high customer service standards. Communicate complex information to both technical and non-technical audiences.  Facilitate collaboration between stakeholders. Supervise staff responsible for MMIS updates.  Establish milestones and assign staff tasks and responsibilities. Analyze, design, plan, execute, and evaluate agency priorities and initiatives.
• Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive.

Why is this position open (new role, increased workload, new dept., resignation, promotion)?

• The workload and complexities of the reference administration responsibilities require additional support to maintain efficiency and to achieve defined deliverable dates.

This position requires an individual with strong analytical skills and experience in:

• Managing multiple work efforts simultaneously
• Medical Coding
• Time management skills
• CPT/HCPCS and ICD-10 translation
• Ability to write and understand business and functional requirements.
• Medicaid Policy, coding changes, system functionality and success implementation of changes for the expected outcome
• Please ensure that your candidates have strengths in these areas. Please do not submit general Medical Coders with no structured background in business rules or claims processing, preferably Government Operations and Managed Care background.
• The candidate must have strong collaboration and relationship building skills.
• Experience in healthcare insurance.

Scope of the project:

• This project is an immediate support need that will primarily focus on providing consulting services to operations and policy staff for the current medical coding federal requirements, quarterly and intermittently, and all coding changes associated with agency initiatives to ensure compliance policy and code change alignment. Note - Medicaid Management Information System (MMIS) is the system of record.
• The current position’s focus and priority is the continued support of serving as a subject matter expert (SME), utilizing knowledge of medical coding and MMIS to support change requests while ensuring change requests and system updates result in the expected claims adjudication outcomes for the benefit of Medicaid members and providers.

Pre-employment Checks?

• State mandatory - Criminal, Credit and E-Verify background checks

Objectives to Be Fulfilled by Candidate:

• The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance.  

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 EDUCATION:

• Bachelor’s degree in Health Information, Healthcare Administration, or related field; equivalent experience may be considered with a minimum of 3+ years of direct supervisor experience.

ADDITIONAL SKILLS/DUTIES:

• Superb written and oral communications skills, strong proficiency in English.
• Strong knowledge of formal business process documentation.
• Ability to effectively communicate with executive management, line management, project management, and team members.

INTERVIEW PROCESS (who will conduct i/v, phone or in-person, how many rounds of i/v)?

• The interviews will be conducted by a team either in-person or via video conferencing.

SCHEDULE INTERVIEW: How soon can you schedule an interview (date / times)?

• Once qualified resumes and candidates have been received.

“Cleo Consulting is an equal opportunity employer (Minorities/Women/Veterans/Disabled)”