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IT Healthcare Consultant - Business Analyst - Advanced (Clinical Analyst & Coding Specialist
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PayCompetitive
LocationColumbia/South Carolina
Employment typeFull-Time
Job Description
- Req#: 26-00890
- Initiate annual and quarterly ICD-10, CPT, and HCPCS coding updates from CMS
- Review and analyze coding changes to determine business and operational impacts
- Prepare code change listings for Reference Administration and Medicaid Program teams
- Conduct meetings with agency personnel, stakeholders, and process owners
- Serve as SME for medical coding methodologies and Medicaid policy
- Research business rules, requirements, and models to provide recommendations
- Maintain business rules and documentation repositories
- Collaborate with teams to ensure documentation and training materials are updated
- Participate in MMIS enhancement and future replacement initiatives
- Support medical necessity reviews when required
- Assist with process improvement initiatives and project-related activities
- Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
- Active, unrestricted South Carolina Registered Nurse (RN) license
- CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification
- ICD-10 proficiency certification or ability to obtain within one year
- 5+ years healthcare insurance experience (medical review, appeals, or program integrity)
- 5+ years working with IT developers/programmers in a payer environment
- 5+ years medical coding experience in payer environment
- 3+ years clinical healthcare experience with strong assessment skills
- 5+ years knowledge of ICD/CPT/HCPCS coding methodologies
- Strong understanding of anatomy, physiology, pharmacology, and medical terminology
- Strong analytical, communication, collaboration, and relationship-building skills
- Experience managing multiple work efforts simultaneously
- Ability to write and understand business and functional requirements
- 5+ years policy remediation experience
- 5+ years claims processing systems experience
- Experience with Optum Encoder and other medical coding software programs
- Government operations and managed care background preferred
- Fully Remote role; however, candidate must currently reside in South Carolina
- No relocation permitted
Job Title: IT Healthcare Consultant - Business Analyst - Advanced (Clinical Analyst & Coding Specialist) (11013)
Location: Columbia, SC (Fully Remote - Candidate must reside in South Carolina)
Duration: 12 Months (Possible Extension)
Interview Process: 1 Round - Virtual/Online
Key Responsibilities
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, gender identity, age, or marital status. We also are a Google Cloud and Oracle partner company.About the company
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