Job Description

Job Title: Business Analyst Consultant (Remote)

Location: Columbia, SC

Duration: 12 Months

Job Description:

The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance.

Specific duties include, but are not limited to:

• Collaborates with internal recipient and owner of initial review of codes to determine scope of changes for planning and timely completion.
• Receives listings of codes changes distributed to the Reference Administration and Medicaid Program staff for review and analysis.
• Serves as an approver within the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
• Serves as lead for meetings with Agency personnel, stakeholders, and process owners.
• Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
• Researches 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.
• Participates in agency projects and related initiatives requiring subject matter expertise.
• Other duties, as assigned or required.

REQUIRED SKILLS

• 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).

REQUIRED EDUCATION:

• 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.

ADDITIONAL SKILLS/DUTIES:

• Superb written and oral communications skills, strong proficiency in English.
• Strong knowledge of formal business process documentation.
• Ability to effectively communicate with executive management, line management, project management, and team members.

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