IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst

Position is 80% Remote, resources will need to come onsite in Columbia, SC for certain trainings/meetings.

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. 

Mandatory Background Checks:

• Criminal
• Credit
• E-Verify 

The position we are seeking to fill is for a candidate with a background in healthcare and is a Certified Medical Coder. The workload and complexities of the reference administration responsibilities require additional support to maintain efficiency and to achieve defined deliverable dates. The additional position will allow us to finalize succession planning for the Reference Administration team.

• This position requires an individual with strong analytical skills and experience in:
  • Managing multiple work efforts simultaneously
  • Medical Coding
  • Clinical background – not required but could be beneficial
  • Time management skills
  • CPT/HCPCS and ICD-10 translation knowledge and ability to learn how medical codes link to claims processing
  • Ability to understand business and functional requirements
• Candidates with hospital, office, or clinic settings experience will be beneficial.
• The candidate must have strong collaboration and relationship building skills.
• Experience in healthcare or degree to align with healthcare environment.

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
• 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 with prior Agency hiring team review and approval.

REQUIRED CERTIFICATIONS:

• Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).

INTERVIEW PROCESS 

• The interviews will be conducted by a team either in-person or via video conferencing.

ADDITIONAL SKILLS:

• Written and oral communications skills, strong proficiency in English
• Ability to effectively communicate with executive management, line management, project management, and team members