IT Healthcare Consultant – Business Analyst

IT Healthcare Consultant – Business Analyst

Type: Long term Contract

Work Location: Columbia, SC

Work Set up: Hybrid (20% onsite - must be available to come onsite periodically)

Candidate

Location:

Candidate MUST be a SC resident. No relocation allowed.

We are seeking an experienced IT Healthcare Consultant – Business Analyst with strong clinical and medical coding expertise to support ongoing Medicaid system operations and code maintenance initiatives. This role serves as a Subject Matter Expert (SME) supporting CPT/HCPCS and ICD-10 code updates, policy analysis, and system enhancements within a payer environment.

This is an excellent opportunity for a Certified Medical Coder with clinical experience who enjoys working on complex, change-oriented projects and collaborating with cross-functional teams.

• Lead CPT/HCPCS and ICD-10 code maintenance activities, including annual and quarterly CMS updates
• Perform impact analysis of coding changes and prepare documentation for review by policy and program stakeholders
• Serve as Subject Matter Expert (SME) for medical coding methodologies and Medicaid policy
• Research business rules, requirements, and models; develop recommendations for policy and operational improvements
• Collaborate with IT developers and programmers to implement coding and system updates
• Participate in MMIS enhancements and future replacement initiatives
• Maintain documentation repositories and support process improvement efforts
• Conduct stakeholder meetings and support training initiatives
• Provide clinical review support as needed

• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)

• Current, active, and non-restricted Registered Nurse (RN) license in the State of South Carolina
• Current CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential
• ICD-10 proficiency demonstrated by exam or ability to obtain certification within one year

• 5+ years in healthcare insurance, medical review, program integrity, or appeals
• 5+ years working with IT developers/programmers in a payer environment
• 5+ years of medical coding experience in a payer environment
• 3+ years of clinical experience in a healthcare setting with strong assessment and critical thinking skills
• 5+ years of ICD/CPT/HCPCS translation and coding methodology expertise
• 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology
• Strong written and verbal communication skills

• 5+ years of policy remediation experience
• 5+ years of claims processing systems experience
• 5+ years proficiency in Microsoft Office
• 5+ years experience with Optum Encoder and/or other medical coding software

This role is ideal for a highly analytical RN with deep coding expertise who thrives in a collaborative, policy-driven healthcare environment and enjoys serving as a technical and clinical resource on complex system initiatives.