Medicaid (MMIS) CPT/HCPCS and ICD-10 translation Business Analyst

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.

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
•    5+ years’ experience in policy remediation.
•    5+ years claims processing systems experience. 
•    5+ years Optum Encoder and/or other medical coding software programs

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.
•    5+ years written and oral communications skills, strong proficiency in English.
•    Knowledge of Microsoft Office Suite