Senior Clinical Coder

Location: Columbia, SC

Work Arrangement: Hybrid

Employment Type: Contract

Interview Mode: 1 Round (Virtual/Online)

Shift: EST

Code Maintenance: Initiate annual and quarterly CMS updates for all ICD-10, CPT, and HCPCS coding changes.

Clinical Analysis: Perform initial reviews of code changes to determine scope and impact on Medicaid policy.

Stakeholder Liaison: Conduct meetings with Agency personnel and stakeholders to present analysis and recommendations.

System Modernization: Provide reference administration expertise for the "DASH" project (Replacement MMIS).

Documentation: Maintain business rules, requirements, and models in the central repository; ensure process documentation is up to date.

Medical Review: Occasionally serve as a back-up to review patient records against established criteria to determine medical necessity.

Healthcare Payer Experience: 5+ years in healthcare insurance (medical review, program integrity, or appeals) within a payer environment.

IT Collaboration: 5+ years working alongside IT developers/programmers.

Medical Coding: 5+ years of professional medical coding in a payer environment, including deep knowledge of ICD/CPT/HCPCS translation.

Clinical Background: 3+ years of clinical experience in a healthcare environment with strong assessment skills.

Medical Knowledge: Comprehensive understanding of anatomy, physiology, pharmacology, and medical terminology.

Education: Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN).

Nursing License: Must have a current, active, and non-restricted Registered Nurse (RN) license from the South Carolina Board of Nursing.

Coding Credentials: Current certification as a CPC (Certified Professional Coder) or CCS (Certified Coding Specialist).

ICD-10: Demonstrated proficiency by exam (or ability to certify within one year).