IT Healthcare Consultant - Business Analyst - Advanced (Clinical Analyst and Coding Specialist)

IT Healthcare Consultant - Business Analyst - Advanced (Clinical Analyst and Coding Specialist)

Location: Columbia SC 29201

On-site/Remote/Hybrid: Hybrid (20% onsite - must be available to come onsite periodically)

Duration: 12 Months

Interview Process: 1 Round Virtual/Online No of submissions: 2 No of Positions: 1

Candidate MUST be a SC resident. No relocation allowed.

Job Description

The Business Analyst will support the medical code change requests by researching and making recommendations to policy and process owners and stakeholders for review and approval. The position will also participate as a project team member, as assigned, for related process improvements, Medicaid Management Information System (MMIS) enhancements and provide subject matter expertise for a future MMIS replacement. The position we are seeking to fill is for a Certified Medical Coder. Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive. The workload and complexities of the reference administration responsibilities requires additional support to maintain efficiency and to achieve defined deliverable dates. The additional position will allow us to finalize succession planning for team members that may consider retirement within the next 12 18 months.

Scope Of The Project

This project is a multi-year 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.

Position

State mandatory - Criminal, Credit and E-Verify background checks

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)

• 5+ 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.

Additional Skills

• 5+ years written and oral communications skills, strong proficiency in English.

Required Education

Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)

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 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.

About Us: InterSources Inc

InterSources Inc, is a Small, Woman, and Minority-Owned Business Enterprise, ISO/IEC 27001, SOC 2 Type 2 certified company with massive 18+ years of diversified experience in providing IT Consulting Services, Artificial Intelligence, Data Analysis, Application Development, Cloud Services, Cybersecurity, Digital Marketing, ERP Management, Custom Software Development, Web Development, UI/ UX Design, System Integration, QA Support etc. We make reasonable accommodations for clients and employees, and we do not discriminate based on any protected attribute including race, religion, color, national origin, gender sexual orientation, gender identity, age, or marital status. We also are a Google Cloud and Oracle partner company.