Business Analyst

Business Analyst - Clinical Analyst

The South Carolina Department of Health & Human Services (SCDHHS) is the State Medicaid Agency for South Carolina. 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 candidate with a background in healthcare and is a Certified Medical Coder. Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive.

WHY IS THIS POSITION OPEN (new role, increased workload, new dept., resignation, promotion)? 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.

WHAT TYPES OF STAFFING CHALLENGES OR HEADACHES HAVE YOU EXPERIENCED IN THE PAST? 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 Please ensure that your candidates have strength in these areas. 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.

POSITION: IT Healthcare Consultant Business Analyst - Advanced PRE-EMPLOYMENT CHECKS? 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 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) Resource is local to South Carolina, North Carolina, or Georgia

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

REQUIRED CERTIFICATIONS: Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).