Role: Clinical Analyst / Medical Coding Specialist-W2 Only
Location: Columbia, SC- Hybrid
Duration: 12 Months contract with possibility of extensions
Job Summary:
The 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.
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 CERTIFICATIONS:
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
Required Skills:
- Bachelor’s degree in healthcare related field.
- Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
- 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
- 3+ years of strong knowledge of formal business process documentation
Preferred Skills:
- 3+ years’ experience healthcare hospital, office and clinic setting
- Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
- Resource is local to South Carolina, North Carolina, or Georgia
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