Clinical Analyst / Certified Medical Coder

Clinical Analyst / Certified Medical Coder

Location: Columbia, SC (Hybrid) Work Arrangement: 80% Remote; occasional onsite travel required Duration: 12 Months Interview: 1 Round Virtual/Online

Candidate Location: Resource can reside anywhere in the United States but must be willing to travel onsite to Columbia, SC for required meetings or training with notice from management. Travel will be at the resource's expense.

Strong preference: Candidates located in South Carolina, North Carolina, or Georgia.

Job Summary

The consultant will research medical coding changes, analyze their impact, and provide recommendations to policy owners, process owners, and stakeholders. The role will also support the current Medicaid Management Information System (MMIS) and may participate in future MMIS replacement initiatives. The ideal candidate will have strong experience with ICD-10, CPT, HCPCS coding, healthcare processes, business analysis, and formal process documentation.

Key Responsibilities

• Initiate annual and quarterly updates from CMS for ICD-10 and CPT/HCPCS coding changes.
• Review medical code changes and determine the scope and impact.
• Prepare code-change information for Reference Administration and Medicaid Program staff.
• Conduct meetings with agency personnel, stakeholders, and process owners.
• Serve as a Subject Matter Expert for medical coding methodologies, Medicaid policy, and related topics.
• Research business rules, requirements, and models and provide analysis and recommendations.
• Maintain business rules, requirements, and related documentation.
• Support process documentation and training content.
• Participate in future DASH / MMIS replacement project meetings as needed.
• Support claim escalation research after gaining proficiency in the role.
• Manage multiple work efforts simultaneously.
• Collaborate with business, technical, policy, and operational teams.

Required Skills

• Bachelor's degree in healthcare related field.
• Currently credentialed as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist).
• 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

• 3+ years' experience healthcare hospital, office and clinic setting.
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs).
• Resource is local to South Carolina, North Carolina, or Georgia.

Additional Skills

• Strong analytical and problem-solving skills.
• Ability to manage multiple work efforts simultaneously.
• Strong time-management skills.
• Ability to understand business and functional requirements.
• Strong collaboration and relationship-building skills.
• Strong written and oral communication skills.

Required Education

Bachelor's degree in a healthcare-related field. An equivalent combination of experience and education may be considered with prior SCDHHS hiring team review and approval.

Required Certification

Candidate must currently hold at least one of the following:

• CPC Certified Professional Coder
• CCS Certified Coding Specialist

About Us

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.