Business analyst (IT healthcare)-advanced.

Primary Skills: Healthcare, ICD-10, CPT/HCPCS Coding,Medical Coding Methodologies, Anatomy, Physiology, Pharmacology, Medical Terminology, Business Process Documentation, Claims Processing, Business Rules Analysis, Requirements Gathering, Process Documentation, Subject Matter Expertise, Stakeholder Collaboration, Microsoft Office (Word, Excel, PowerPoint), Optum Encoder, Medical Coding Software.
PS: Candidate should be extensively familar with all the medical terminology

This project is a multi-year-old effort which primarily focuses on providing consulting services to operations and policy staff for the current MMIS. The current position's focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers. It is necessary to build and sustain a strong staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding, and applies the codes correctly within the Reference Administration sub-system.

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 code 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 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 & Qualifications:

• 9-10 years of overall experience with minimum 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:

• 3+ years' experience in healthcare hospital, office, and clinic settings

• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder, and other medical coding software programs)

• Preference for resources 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 resource's expense

Required Certifications: Currently credentialed as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist)

Required Education: Bachelor's degree in a healthcare-related field; an equivalent combination of experience and education may be considered with prior hiring team review and approval