Will close to submissions on 05/27 at 5:00PM EST. 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.
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 review patient records against established criteria to determine medical necessity.
Other project-related duties.
5 years written and oral communications skills strong proficiency in English.
Knowledge of Microsoft Office Suite
Required Skills (rank in order of Importance):
5 years in healthcare insurance; medical review program integrity or appeals.
5 years working with IT developers/programmers in a payor environment.
5 years Medical Coding in payer environment.
3 years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
5 years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
5 years knowledge of anatomy physiology pharmacology and medical terminology.
Preferred Skills (rank in order of Importance):
5 years experience in policy remediation.
5 years claims processing systems experience.
5 years Optum Encoder and/or other medical coding software programs
Required Education:
Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
Required Certifications:
Must have current active and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.
Will close to submissions on 05/27 at 5:00PM EST. 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. Objectives to Be Fulfilled ...
Will close to submissions on 05/27 at 5:00PM EST. 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.
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 review patient records against established criteria to determine medical necessity.
Other project-related duties.
5 years written and oral communications skills strong proficiency in English.
Knowledge of Microsoft Office Suite
Required Skills (rank in order of Importance):
5 years in healthcare insurance; medical review program integrity or appeals.
5 years working with IT developers/programmers in a payor environment.
5 years Medical Coding in payer environment.
3 years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
5 years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
5 years knowledge of anatomy physiology pharmacology and medical terminology.
Preferred Skills (rank in order of Importance):
5 years experience in policy remediation.
5 years claims processing systems experience.
5 years Optum Encoder and/or other medical coding software programs
Required Education:
Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
Required Certifications:
Must have current active and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.
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