Remote Clinical AnalystCoding Specialist (SC RNCPCCCS) with ICD-10CPTHCPCS

Job ID: SC-11013 ()

Remote Clinical Analyst/Coding Specialist (SC RN/CPC/CCS) with ICD-10/CPT/HCPCS Optum Encoder payer/insurance and claims processing systems anatomy/physiology/pharmacology experience

Location: Columbia SC (SCDHHS)
Duration: 12 Months

Required Skills
Certification: Must have current active and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
Education: Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
Certification: 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.
Education: 5 years in healthcare insurance; medical review program integrity or appeals.
Experience: 5 years working with IT developers/programmers in a payor environment.
Education: 5 years Medical Coding in payer environment
Experience: 3 years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
Education: 5 years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
Experience: 5 years knowledge of anatomy physiology pharmacology and medical terminology.
Required Skills (Ranked in Order of Importance):
1. 5 years in healthcare insurance; medical review program integrity or appeals.
2. 5 years working with IT developers/programmers in a payor environment.
3. 5 years Medical Coding in payer environment
4. 3 years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
5. 5 years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
6. 5 years knowledge of anatomy physiology pharmacology and medical terminology.
Preferred Skills
Experience: 5 years experience in policy remediation.
Experience: 5 years claims processing systems experience.
Experience: 5 years Optum Encoder and/or other medical coding software programs
Job Responsibilities
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.
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

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