IT - SCDHHS - IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst

Company / Department Culture:

The South Carolina Department of Health & Human Services (SCDHHS) is the State Medicaid Agency for South Carolina. We are seeking a candidate with a background in healthcare and a Certified Medical Coder to support medical code change requests. The candidate will research and make recommendations to policy and process owners and stakeholders for review and approval. This role involves participation as a project team member for process improvements, Medicaid Management Information System (MMIS) enhancements, and providing subject matter expertise for a future MMIS replacement. Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive.

Why is This Position Open?

The workload and complexities of the reference administration responsibilities require additional support to maintain efficiency and achieve defined deliverable dates. This additional position will also help finalize succession planning for the Reference Administration team.

Staffing Challenges:

• Recruiters submitting multiple, clearly unqualified candidates.
• This position requires an individual with strong analytical skills and experience in managing multiple work efforts simultaneously, medical coding, and time management skills.
• Candidates with hospital, office, or clinic settings experience will be beneficial.
• The candidate must have strong collaboration and relationship-building skills.
• Experience in healthcare or a degree to align with the healthcare environment.

Scope of the Project:

This project is a multi-year effort primarily focused on providing consulting services to operations and policy staff for the current Medicaid Management Information System (MMIS). The position's focus and priority are to serve as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers.

Objectives to be Fulfilled by Candidate:

The principal duties of this position include assisting with the CPT/HCPCS and ICD-10 code maintenance. Specific duties include, but are not limited to:

• Initiating annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
• Performing initial review of codes to determine the scope of changes.
• Preparing listings of code changes for Reference Administration staff and Medicaid Program staff for review and analysis.
• Conducting meetings with Agency personnel, stakeholders, and process owners.
• Participating in DASH (Replacement MMIS) project meetings, as needed.
• Serving as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
• Researching business rules, requirements, and models to complete initial analysis and recommendations.
• Maintaining business rules, requirements, and models in a repository.
• Collaborating with the team to ensure process documentation is complete and training content is updated.
• Serving as a back-up to other roles within the bureau to support claim escalations research, once proficiency is demonstrated.

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 in healthcare hospital, office, and clinic settings.
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder, and other medical coding software programs).

Required Education:

Bachelor's degree in a 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).

Location:

This position is located in Columbia, SC, a vibrant city known for its rich history, diverse culture, and growing tech scene. Enjoy a balanced lifestyle with access to outdoor activities, a thriving arts community, and a welcoming atmosphere.