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IT Healthcare Consultant - Business Analyst - Consultant

Columbia, SC, US • Posted 13 hours ago • Updated 13 hours ago

Contract W2

Contract Corp To Corp

12 Months

On-site

Depends on Experience

Syntricate

Fitment

Dice Job Match Score™

👾 Reticulating splines...

Job Details

Skills

ANATOMY
PHYSIOLOGY
PHARMACOLOGY
INSURANCE
PAYER
CODING

Summary

Requisition Name: IT Healthcare Consultant - Business Analyst - Consultant
Work Address – Columbia, South Carolina
Interview Process: 1 round, Virtual/Online
Duration of the Contract: 12 months
Possibility for Extension: Yes
Work Location: Hybrid (80% remote, onsite for required training''s and meetings).

Description
The position we are seeking to fill is for a Certified Medical Coder.

IT Healthcare Consultant – Business Analyst – Advanced (Clinical Analyst and Coding Specialist)

Position Summary
The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. The IT Healthcare Consultant – Business Analyst – Advanced (Clinical Analyst and Coding Specialist) will support coding maintenance, business analysis, Medicaid policy initiatives, and collaboration with stakeholders to ensure compliance and operational efficiency.

Key Responsibilities

Initiate annual and quarterly updates from CMS for all ICD-10 and CPT/HCPCS coding changes.
Perform initial review of codes to determine the scope of changes.
Prepare listings of code changes for Reference Administration staff and Medicaid Program staff for review and analysis.
Conduct meetings with agency personnel, stakeholders, and process owners.
Participate in DASH (Replacement MMIS) project meetings, as needed, where Reference Administration expertise is required. (Future responsibility)
Serve as the 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 provide recommendations.
Maintain business rules, requirements, and models in a repository.
Collaborate with the team to ensure process documentation is complete and that owner/stakeholder training content is complete and routinely updated.
Serve as a backup, as needed, to review patient records against established criteria to determine medical necessity.
Perform other project-related duties as assigned.

Required Skills (Ranked by Importance)

10+ years of experience in healthcare insurance, medical review, program integrity, or appeals.
5+ years of experience working with IT developers/programmers in a payer environment.
5+ years of medical coding experience in a payer environment.
3+ years of clinical experience in a healthcare environment with strong clinical assessment and critical thinking skills.
5+ years of knowledge of ICD/CPT/HCPCS translation and coding methodologies.
5+ years of knowledge of anatomy, physiology, pharmacology, and medical terminology.

Preferred Skills (Ranked by Importance)

5+ years of experience in policy remediation.
5+ years of claims processing systems experience.
5+ years of proficiency with Microsoft Office.
5+ years of experience using Optum Encoder and/or other medical coding software programs.

Required Education

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

Required Certifications

Current, active, and unrestricted Registered Nurse (RN) licensure issued by the South Carolina Board of Nursing.
Current credential as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist).
Demonstrated ICD-10 proficiency by examination, or the ability to obtain certification within one year of employment.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 91142014
Position Id: 26-02264
Posted 13 hours ago

Company Info

About Syntricate

We are here to analyze and resolve the most intricate processes and deliver market’s best solution and services to your business problems.

Syntricate Technologies is an Information Technology and Business Consulting company that offers comprehensive solutions to our clients for Quality Assurance, Validation, Regulatory, Business Analysis and Project Management services. Our core values are integrity, delivering value and making positive impact on society. We are committed to our client success and work on high standards to provide the best professional services.

We believe in effective integration of technology to improve business processes. We provide solutions that address the current and long-tern needs of our clients nationwide which range from various industries such as Healthcare, Pharmaceutical, Life Sciences, Finance and Insurance.

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