Business Analyst

Job ID: SC-10851 ()

Remote/Local Healthcare BA with insurance/appeals payer Medical Coding clinical CMS/ICD-10/CPT/HCPCS Optum Encoder Claim processing policy remediation Medicaid/MMIS experience

Location: Columbia SC (SCDHHS)
Duration: 12 Months
Work Location: Fully Remote
Candidate Location: Candidate MUST be a SC resident. No relocation allowed.

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
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.

REQUIRED EDUCATION:
Bachelors 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.

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
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).

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.

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 positions 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.

OBJECTIVES TO BE FULFILLED BY CANDIDATE:
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.

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