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Job Details

Skills

Business Rules
Critical Thinking
Dash Python
Documentation
HCPCS
Health Care
Health Insurance
ICD
ICD-10
MMIS
Medicaid
Medical Classification
Medical Terminology
Microsoft Office
Nursing
Pharmacology
Research
Science
Training
Translation

Summary

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 review patient records against established criteria to determine medical necessity.
Other project-related duties.

Required Skills (rank in order of Importance):

10+ 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 knowledge of Microsoft Office
5+ years 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:

Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.

Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified 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: 10289500
Position Id: 9030446
Posted 21 hours ago

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Ganesan Natarajan

Recruiter @ Omega Solutions Inc

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Columbia, South Carolina

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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 Summ

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Third Party, Contract

Depends on Experience

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Location: Columbia, SC Duration: 12 Months REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE): 10+ 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 know

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We are seeking a Clinical Analyst & Coding Specialist to serve as a Subject Matter Expert (SME) supporting state healthcare programs and Medicaid systems. Position Details Location: Columbia, SC Work Arrangement: Hybrid (80% Remote / Onsite for required trainings & meetings) Candidate Requirement: Must be a current South Carolina Resident Interview Process: 1-Round Virtual/Online Interview The Core Role You will bridge the gap between clinical expertise, medical coding, and IT systems. Princi

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Requirements 10 or more years of experience in healthcare insurance operations, medical reviews, or program integrity. Proficiency in ICD-10, CPT, and HCPCS medical coding translation methodologies. Experience with clinical nursing operations and possessing an active Registered Nurse (RN) licensure. Experience in a healthcare payer environment collaborating directly with software developers and programmers. Experience with specialized medical coding software such as Optum Encoder and enterprise

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Depends on Experience

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IT Healthcare Consultant Business Analyst Consultant

Skills

Summary

Dice Job Match Score™

Ganesan Natarajan

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IT Healthcare Consultant Business Analyst Consultant

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Dice Job Match Score™

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