Healthcare Business Analyst - Medical Coding

Healthcare Business Analyst – Medical Coding Type:
Long-term Contract (Potential for Extension)

Location:

Columbia, SC / Primarily Remote Work Setting:
Approximately 80% Remote with onsite meetings and training as required

We are seeking an experienced Healthcare Business Analyst – Medical Coding to support medical coding, business analysis, and Medicaid system initiatives within a large healthcare environment. This position combines medical coding expertise with business analysis responsibilities and will focus heavily on CPT/HCPCS and ICD-10 code maintenance, analysis, documentation, and recommendations. The consultant will serve as a subject matter expert supporting policy and process stakeholders, ongoing Medicaid system operations and enhancements, and future system modernization initiatives.

Current CPC or CCS certification is required for consideration.

• Manage annual and quarterly updates involving ICD-10 and CPT/HCPCS coding changes.
• Review medical code changes and determine their scope and potential impact.
• Prepare coding-change documentation for program, policy, and operational stakeholders.
• Serve as a subject matter expert on medical coding methodologies, Medicaid policy, and related processes.
• Help stakeholders understand and correctly apply CPT/HCPCS and ICD-10 codes.
• Research business rules, requirements, and models and develop initial analyses and recommendations.
• Maintain business rules, requirements, and supporting documentation within established repositories.
• Facilitate meetings with business stakeholders, process owners, and other project participants.
• Support business and functional requirements associated with healthcare system processes.
• Participate in process-improvement and Medicaid system enhancement initiatives.
• Provide subject matter expertise supporting future Medicaid Management Information System (MMIS) modernization/replacement activities.
• Collaborate with team members to maintain process documentation and training materials.
• Support claims-escalation research after achieving proficiency with applicable processes.
• Manage multiple concurrent work efforts and priorities.

• Current CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential.
• 3+ years of healthcare experience.
• Strong knowledge of ICD-10, CPT, and HCPCS coding and translation methodologies.
• 3+ years of extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.
• 3+ years of experience with formal business process documentation.
• Ability to understand and document business and functional requirements.
• Strong analytical and research skills.
• Ability to manage multiple work efforts simultaneously.
• Strong time-management and organizational skills.
• Strong collaboration and relationship-building abilities.
• Strong written and verbal communication skills.
• Ability to communicate effectively with executive management, line management, project management, and technical/business team members.
• Bachelor's degree in a healthcare-related field.
• An equivalent combination of education and experience may be considered subject to approval.

• 3+ years of healthcare experience within a hospital, physician office, or clinical setting.
• Experience with Medicaid or other government healthcare programs.
• Experience supporting healthcare claims or understanding how medical codes affect claims processing.
• Experience with MMIS environments or healthcare system modernization initiatives.
• Clinical background or experience.
• Experience with Optum Encoder or other medical coding software.
• Proficiency with Microsoft Word, Excel, and PowerPoint.
• Candidates located in South Carolina, North Carolina, or Georgia are strongly preferred.

The ideal candidate is a certified medical coder who also brings strong business analysis capabilities. This person should be highly knowledgeable in CPT/HCPCS and ICD-10 coding, comfortable researching and interpreting coding changes, and able to translate that information into clear recommendations, business requirements, and process documentation. Experience connecting medical coding to claims processing, Medicaid operations, or MMIS systems would be particularly relevant.

The successful candidate should also be comfortable working independently, collaborating with multiple stakeholders, and managing several priorities simultaneously.

Position is approximately 80% remote.

Periodic onsite attendance in…