Systems Software Programmer Consultant
InterSources Inc.Columbia, SC
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Overview
Remote
On-site
Job Description
Job Title: IT Healthcare Consultant – Business Analyst – Consultant (12771)Location: Columbia, SC 29201Work Arrangement: Hybrid – approximately 80% remote; onsite for required training and meetingsCandidate Location:Must be a current South Carolina resident. No relocation allowed.Contract: 12 Months, with possible extensionInterview: 1 Round – Virtual/OnlineStatus: RebidJob Overview: The consultant will serve as a medical coding SME, supporting CPT/HCPCS and ICD-10 code maintenance, researching coding changes, analyzing business rules, working with Medicaid program stakeholders, and supporting current and future MMIS enhancements. The SOW specifically identifies this position as being focused on a Certified Medical Coder supporting South Carolina Medicaid. Key Responsibilities
- Manage annual and quarterly ICD-10 and CPT/HCPCS coding updates from CMS.
- Review coding changes and determine their impact on Medicaid policies and processes.
- Prepare code-change documentation for Medicaid program and reference administration teams.
- Serve as an SME for medical coding methodologies, Medicaid policy, and healthcare processes.
- Research and document business rules, requirements, and recommendations.
- Collaborate with policy owners, stakeholders, IT developers, and project teams.
- Support MMIS enhancements and future MMIS replacement/DASH initiatives.
- Assist with medical necessity reviews when required.
- BSN or ADN required.
- Current, active, unrestricted South Carolina Registered Nurse license – mandatory.
- Current CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential.
- ICD-10 proficiency demonstrated by exam, or ability to obtain certification within one year.
- 10+ years healthcare insurance experience involving 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 healthcare experience with strong clinical assessment and critical-thinking skills.
- 5+ years knowledge of ICD/CPT/HCPCS coding and translation methodologies.
- 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.
- 5+ years policy remediation experience.
- 5+ years claims processing systems experience.
- 5+ years Microsoft Office experience.
- 5+ years with Optum Encoder or similar medical coding software.
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FAQs About Systems Software Programmer Consultant Jobs at InterSources Inc.
What is the work location for this position at InterSources Inc.?
This job at InterSources Inc. is located in Columbia, SC, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at InterSources Inc.?
Employer has not shared pay details for this role.
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