Please note that this position is with our direct client "
We are looking Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst (Min 3+yrs Exp) REMOTE (Web Cam Interview)
DIRECT CLIENT Position
Number of positions: 1
Length: 12Months +
Work Address: Columbia, SC 29210
looking for an IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst
Work Location: 80% remote, resources will need to come onsite in Columbia, SC to certain trainings/meetings
Candidate Location: Resource can reside anywhere in the US - must be willing to travel onsite to Columbia, SC within notice from management at the resources expense. Strong preference for resources that are local to SC, NC, or GA.
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.
POSITION: IT Healthcare Consultant Business Analyst -Advance
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
3+ years of strong knowledge of formal business process documentation
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 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
REQUIRED CERTIFICATIONS:
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified
Coding Specialist)
ADDITIONAL SKILLS / Notes:
-
Written and oral communications skills, strong proficiency in English
-
Ability to effectively communicate with executive management, line management,project management, and team members
Required/Desired Skills
Candidates must have ALL the "Required" skills in order to be considered for the position. "Desired" or "Highly Desired" skills are a PLUS but may NOT be required.
Skill Matrix
| Experience with Business workflow processes | Required / Desired | Amount of Experience | Years of Experience |
| Bachelor's degree in healthcare related field. | Required | | |
| Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). | Required | | |
| 3+ years' experience in healthcare | Required | 3 | Years |
| Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies | Required | | |
| 3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology | Preferred | 3 | Years |
| 3+ years of strong knowledge of formal business process documentation | Required | 3 | Years |
| 3+ years' experience healthcare hospital, office and clinic setting | Preferred | 3 | Years |
| Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs) | Preferred | | |
| Resource is local to South Carolina, North Carolina, or Georgia | Preferred | | |
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