Business Analyst - Advanced - Clinical Analyst

Business Analyst
- Advanced
- Clinical Analyst

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).

ADDITIONAL SKILLS / Notes:

• Written and oral communications skills, strong proficiency in English
• Ability to effectively communicate with executive management, line management, project management, and team members

Benefits at Intelli Bee

• Long-Term Stability: Join us on a multi-year opportunities with room to grow.
• Comprehensive Health Coverage: Access quality healthcare benefits to keep you and your family well.
• Future Planning: Enroll in our 401(k) program and invest in your financial security.
• GC Assistance: We support immediate Green Card processing, if required.