*** no c2c * *** W2 only***Web Cam Interview***Primarily Remote***
Job Description:
Company / Department Culture
Our client is the State Medicaid Agency for South Carolina. The Business Analyst will support the medical code change requests by researching and making recommendations to policy and process owners and stakeholders for review and approval. 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 MMIS replacement. The position we are seeking to fill is for a candidate with a background in healthcare and is a Certified Medical Coder. Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive.
Scope of the Project
This project is a multi-year-old effort which primarily focuses on providing consulting services to operations and policy staff for the current Medicaid Management Information System (MMIS). The current position's focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers. It is necessary to build and sustain a strong staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and apply the codes correctly within the Reference Administration sub-system.
Objectives to Be Fulfilled by Candidate
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 other roles within the bureau to support claim escalations research, once the person has demonstrated full proficiency in the job functions required for their new role
- Other project-related duties, as assigned or required
Required Skills (Rank in Order of Importance)
- 3+ years' experience in healthcare
- Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
- 3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
Preferred Skills (Rank in Order of Importance)
- 3+ years' experience healthcare hospital, office and clinic setting
- Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding
- 3+ years of strong knowledge of formal business process documentation software programs)
- Other: preference for resources that are local to SC, NC, or GA. Resources can reside anywhere in the US – but must be willing to travel onsite to Columbia, SC within notice from management at the resources expense.
Required Education
Bachelor's degree in healthcare related field. An equivalent combination of experience and education may be considered with prior SCDHHS hiring team review and approval.
Required Certifications
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
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