Medical Coding Business Analyst - REMOTE - Must have CPC or CCS Certification

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 other roles within the bureau to support claim escalations research, once the person has demonstrated full proficiency in the job functions required for their new role
• Other project-related duties, as assigned or required

Required Skills (rank in order of Importance):

3+ years' experience in healthcare

• Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
• 3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
• 3+ years of strong knowledge of formal business process documentation

Preferred Skills (rank in order of Importance):

• 3+ years' experience healthcare hospital, office and clinic setting
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
• Other: preference for resources that are local to SC, NC, or GA. Resources can reside anywhere in the US but must be willing to travel onsite to Columbia, SC within notice from management at the resources expense.

Required Education:

Bachelor's degree in healthcare related field. An equivalent combination of experience and education may be considered with prior SCDHHS hiring team review and approval.

Required Certifications:

Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).

Interview Process (who will conduct i/v, phone or in-person, how many rounds of i/v)?

The interviews will be conducted by a team either in-person or via video conferencing.

Schedule Interview: How soon can you schedule an interview (date / times)?

Once qualified resumes and candidates have been received.