IT - Scdhhs - IT Healthcare Consultant - Business Analyst - Advanced

Job Title: IT Healthcare Consultant – Business Analyst (Advanced)Role Type: Contract Department: Medicaid Operations / MMIS SupportLocation: Columbia, South CarolinaAbout the Organization The South Carolina Department of Health & Human Services (SCDHHS) serves as the State Medicaid Agency for South Carolina. The agency is responsible for administering Medicaid programs that support healthcare services for eligible members across the state. This role supports complex, change-driven initiatives within Medicaid operations and the current Medicaid Management Information System (MMIS), with future involvement in MMIS replacement (DASH). Candidates who enjoy working in collaborative, analytical, and policy-driven environments will thrive in this position.Position Summary SCDHHS is seeking an IT Healthcare Consultant – Business Analyst (Advanced) with strong medical coding expertise and clinical experience. This position serves as a Subject Matter Expert (SME) for medical coding methodologies, Medicaid policy, and reference administration. The primary focus of this role is supporting CPT/HCPCS and ICD-10 code maintenance, conducting research, providing recommendations to policy owners, and collaborating with IT and operational teams to support MMIS enhancements and improvements.Key Responsibilities

• Initiate and manage annual and quarterly CMS updates for ICD-10, CPT, and HCPCS codes.
• Perform impact analysis and scope assessment of coding changes.
• Prepare and distribute code change listings to Reference Administration and Medicaid Program staff.
• Conduct meetings with agency personnel, stakeholders, and process owners to review findings and recommendations.
• Participate in DASH (MMIS replacement) project meetings as coding and reference administration SME.
• Serve as agency SME for medical coding methodologies and Medicaid policy.
• Research business rules, requirements, and regulatory models.
• Develop and maintain documentation repositories for business rules and requirements.
• Collaborate with cross-functional teams to ensure process documentation and training materials are complete and updated.
• Provide backup support for medical necessity reviews and patient record analysis.
• Support other project-related duties as assigned.

Required QualificationsExperience

• 5+ years in healthcare insurance (medical review, program integrity, or appeals).
• 5+ years working with IT developers/programmers in a payer environment.
• 5+ years medical coding experience in a payer environment.
• 3+ years clinical experience in a healthcare setting.
• 5+ years knowledge of ICD-10, CPT, and HCPCS coding methodologies.
• 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.
• Strong written and verbal communication skills.

Education

• Bachelor of Science in Nursing (BSN) OR
• Associate Degree in Nursing (ADN)

Certifications (Required)

• Active, unrestricted Registered Nurse (RN) license issued by the State of South Carolina Board of Nursing.
• Certified Professional Coder (CPC) OR Certified Coding Specialist (CCS).
• ICD-10 Proficiency (certified or able to obtain within one year of employment).

Preferred Qualifications

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