Business Analyst Health Care

Business Analyst Health Care

The consultant will support CPT/HCPCS and ICD-10 code maintenance, Medicaid policy and process activities, and the current Medicaid Management Information System (MMIS). The ideal candidate will have strong knowledge of medical coding methodologies, healthcare processes, business requirements, and documentation.

The candidate will also serve as a Subject Matter Expert (SME) for medical coding, Medicaid policy, and Reference Administration activities.

Key Responsibilities

• Manage annual and quarterly CMS updates for ICD-10, CPT, and HCPCS coding changes.
• Review new and revised medical codes and determine the scope and impact of changes.
• Prepare code-change listings for Reference Administration and Medicaid program teams.
• Research and analyze medical coding rules, business rules, requirements, and processes.
• Provide recommendations to policy owners, process owners, and other stakeholders.
• Participate in meetings with agency personnel, stakeholders, and project teams.
• Serve as a medical coding and healthcare SME for Medicaid-related activities.
• Support current MMIS operations and future MMIS replacement initiatives.
• Maintain business rules, requirements, process models, and related documentation in the appropriate repository.
• Develop and maintain process documentation and training materials.
• Collaborate with project teams, management, policy teams, and business stakeholders.
• Support claim escalation research after gaining proficiency in the primary responsibilities.
• Participate in process improvement and MMIS enhancement initiatives.
• Perform other project-related duties as assigned.

Required Skills

• 3+ years of healthcare industry experience.
• Strong knowledge of ICD-10, CPT, and HCPCS coding and translation.
• Strong understanding of medical coding methodologies.
• 3+ years of knowledge of anatomy, physiology, pharmacology, and medical terminology.
• Strong analytical and problem-solving skills.
• Ability to understand and analyze business and functional requirements.
• Experience managing multiple tasks and priorities simultaneously.
• Strong time-management and organizational skills.
• Excellent communication and stakeholder-management skills.
• Ability to work independently with minimal supervision.
• Strong collaboration and relationship-building skills.

Preferred Skills

• Healthcare experience in hospital, clinical, physician office, or healthcare facility environments.
• Experience with Medicaid or MMIS environments.
• Knowledge of Microsoft Word, Excel, and PowerPoint.
• Experience with Optum Encoder or other medical coding software.
• Strong business process documentation experience.
• Experience with healthcare business analysis and process improvement.
• Clinical background is a plus.
• Candidates local to South Carolina, North Carolina, or Georgia are preferred, but candidates anywhere in the U.S. may be considered.

Education

Required:

• Bachelor s degree in a healthcare-related field.

An equivalent combination of education and experience may be considered with prior SCDHHS hiring team approval.

Required Certification

Candidate must currently hold one of the following:

• CPC Certified Professional Coder
• CCS Certified Coding Specialist