Job Description

Business Analyst – Consultant

Why is this position open: New Position - The Business Analyst Consultant will support the medical code change requests by researching processes for policy and process owners and stakeholders for review and approval and supporting the updates.

This position requires an individual with strong analytical skills and experience in:

• Managing multiple work efforts simultaneously
• Medical Coding
• Time management skills
• CPT/HCPCS and ICD-10 translation
• Ability to write and understand business and functional requirements.
• Medicaid Policy, coding changes, system functionality and success implementation of changes for the expected outcome

• Please ensure that your candidates have strength in these areas. Please do not submit general Medical Coders with no structured background in business rules or claims processing, preferably Government Operations and Managed Care background.
• The candidate must have strong collaboration and relationship building skills.
• Experience in healthcare insurance.

SCOPE OF THE PROJECT:

This project is an immediate support need that will primarily focus on providing consulting services to operations and policy staff for the current medical coding federal requirements, quarterly and intermittently, and all coding changes associated with agency initiatives to ensure compliance policy and code change alignment. Note - Medicaid Management Information System (MMIS) is the system of record. The current position’s focus and priority is the continued support of serving as a subject matter expert (SME), utilizing knowledge of medical coding and MMIS to support change requests while ensuring change requests and system updates result in the expected claims adjudication outcomes for the benefit of Medicaid members and providers.

Interview Process: 1 round, Virtual/Online

Duration of the Contract: 12 months

Possibility for Extension: Yes

Work Location: Fully Remote

Candidate Location: Candidate MUST be a SC resident. No relocation allowed.

Required Skills:

Bachelor’s degree in Health Information, Healthcare Administration, or related field; equivalent experience may be considered with a minimum of 3+ years of direct supervisor experience.

5+ years’ experience in healthcare insurance; medical review, program integrity, or appeals.

5+ years’ experience working with IT developers/programmers in a payor environment.

5+ years' experience Medical Coding in payer environment.

3+ years' clinical experience in a healthcare environment (Strong clinical assessment and critical thinking skills.)

5+ years' strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.

Preferred Skills:

5+ years' experience in policy remediation.

5+ years' Medical Claim processing systems experience.

Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs).

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