Job Description
Job Title: IT Healthcare Consultant – Business Analyst – Consultant (12771)
Location: Columbia, SC 29201
Work Arrangement: Hybrid – approximately 80% remote; onsite for required training and meetings
Candidate Location:Must be a current South Carolina resident. No relocation allowed.
Contract: 12 Months, with possible extension
Interview: 1 Round – Virtual/Online
Status: Rebid
Job Overview: The consultant will serve as a medical coding SME, supporting CPT/HCPCS and ICD-10 code maintenance, researching coding changes, analyzing business rules, working with Medicaid program stakeholders, and supporting current and future MMIS enhancements. The SOW specifically identifies this position as being focused on a Certified Medical Coder supporting South Carolina Medicaid.
Key Responsibilities
About Us:
InterSources Inc , is a Small, Woman, and Minority-Owned Business Enterprise, ISO/IEC 27001, SOC 2 Type 2 certified company with massive 18+ years of diversified experience in providing IT Consulting Services, Artificial Intelligence, Data Analysis, Application Development, Cloud Services, Cybersecurity, Digital Marketing, ERP Management, Custom Software Development, Web Development, UI/ UX Design, System Integration, QA Support etc. We make reasonable accommodations for clients and employees, and we do not discriminate based on any protected attribute including race, religion, color, national origin, gender sexual orientation,
Location: Columbia, SC 29201
Work Arrangement: Hybrid – approximately 80% remote; onsite for required training and meetings
Candidate Location:Must be a current South Carolina resident. No relocation allowed.
Contract: 12 Months, with possible extension
Interview: 1 Round – Virtual/Online
Status: Rebid
Job Overview: The consultant will serve as a medical coding SME, supporting CPT/HCPCS and ICD-10 code maintenance, researching coding changes, analyzing business rules, working with Medicaid program stakeholders, and supporting current and future MMIS enhancements. The SOW specifically identifies this position as being focused on a Certified Medical Coder supporting South Carolina Medicaid.
Key Responsibilities
- Manage annual and quarterly ICD-10 and CPT/HCPCS coding updates from CMS.
- Review coding changes and determine their impact on Medicaid policies and processes.
- Prepare code-change documentation for Medicaid program and reference administration teams.
- Serve as an SME for medical coding methodologies, Medicaid policy, and healthcare processes.
- Research and document business rules, requirements, and recommendations.
- Collaborate with policy owners, stakeholders, IT developers, and project teams.
- Support MMIS enhancements and future MMIS replacement/DASH initiatives.
- Assist with medical necessity reviews when required.
- BSN or ADN required.
- Current, active, unrestricted South Carolina Registered Nurse license – mandatory.
- 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.
- 10+ years healthcare insurance experience involving medical review, program integrity, or appeals.
- 5+ years working with IT developers/programmers in a payer environment.
- 5+ years medical coding experience in a payer environment.
- 3+ years clinical healthcare experience with strong clinical assessment and critical-thinking skills.
- 5+ years knowledge of ICD/CPT/HCPCS coding and translation methodologies.
- 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.
- 5+ years policy remediation experience.
- 5+ years claims processing systems experience.
- 5+ years Microsoft Office experience.
- 5+ years with Optum Encoder or similar medical coding software.
About Us:
InterSources Inc , is a Small, Woman, and Minority-Owned Business Enterprise, ISO/IEC 27001, SOC 2 Type 2 certified company with massive 18+ years of diversified experience in providing IT Consulting Services, Artificial Intelligence, Data Analysis, Application Development, Cloud Services, Cybersecurity, Digital Marketing, ERP Management, Custom Software Development, Web Development, UI/ UX Design, System Integration, QA Support etc. We make reasonable accommodations for clients and employees, and we do not discriminate based on any protected attribute including race, religion, color, national origin, gender sexual orientation,
Numbers & Facts
| Location | Columbia, SC |
| Industry | Computer/IT Services |
| Company Size | 100 to 499 employees |
| Year Founded | 2007 |
| Website | https://www.intersourcesinc.com/ |
About Company
It’s all about harnessing the real power of data. InterSources Inc was founded in 2007 providing intelligent data solutions to clients across industries and geographies.
Over the years, we have built products on Business Intelligence & Big Data platform simplifying and transforming the way business intelligence and real-time data analytics empower Corporations and end-users using Softwares like Tableau, Business Objects, MicroStrategy, etc.
In the process, we have enabled companies to use data analytics to help better understand, predict and influence consumer behavior, identify new market opportunities as they emerge, provide to users the data they need, alert the user when and why key business metrics have changed and enable them to make smart decisions.
Skills
- Anatomyunmatched
- Artificial Intelligence (AI)unmatched
- Business Analysisunmatched
- Certified Coding Specialist (CCS)unmatched
- Certified Professional Coder (CPC)unmatched
- Claims Processingunmatched
- Clinical Assessmentunmatched
- Cloud Applicationsunmatched
- Code Reviewsunmatched
- Computer Programmingunmatched
- Consultingunmatched
- Content Management Systems (CMS)unmatched
- Current Procedural Terminology (CPT)unmatched
- Data Analysisunmatched
- Documentationunmatched
- ERP (Enterprise Resource Planning)unmatched
- Health Information Technologyunmatched
- Health Insuranceunmatched
- Healthcareunmatched
- Healthcare Common Procedure Coding System (HCPCS)unmatched
- Healthcare Softwareunmatched
- ICD-10unmatched
- ISO (International Organization for Standardization)unmatched
- Information Technology Consultingunmatched
- International Classification of Diseases (ICD)unmatched
- International Electro-Technical Commission (IEC)unmatched
- Internet Securityunmatched
- Medicaidunmatched
- Medical Assistanceunmatched
- Medical Codingunmatched
- Medical Terminologyunmatched
- Microsoft Officeunmatched
- Online Marketingunmatched
- Pharmacologyunmatched
- Physiologyunmatched
- Quality Assuranceunmatched
- Registered Nurse (RN)unmatched
- Software Developmentunmatched
- Software Engineeringunmatched
- Statement of Work (SOW)unmatched
- System Integration (SI)unmatched
- Systems/Internals Programmingunmatched
- User Experience Design (UXD)unmatched
- User Interface Designunmatched
- Web Programmingunmatched
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