Business Analyst - Advanced - Clinical Analyst

Technix LLC; Columbia (SC); Hybrid; USD 90,000 - 130,000; Part time

Job summary

Technix LLC seeks an IT Healthcare Consultant - Advanced - Clinical Analyst to support Medicaid MMIS through expert CPT/HCPCS and ICD-10 coding knowledge. The ideal candidate will translate codes to claims processing and maintain business rules and documentation.

Travel to Columbia, SC is required for trainings, with 80% remote work flexibility for qualified candidates. Applicants should have healthcare experience, CPC/CCS credentials, and strong collaboration skills to work with policy staff

Qualifications

• 3+ years of 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.
• Experience in hospital, clinic or office settings preferred.

Responsibilities

• 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 for 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.
• 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 proficiency is demonstrated.

Skills

Healthcare IT

Medical Coding

CPT/HCPCS ICD-10

Time management

Stakeholder collaboration

Education

Bachelor's degree in healthcare

Tools

Microsoft Office

Optum Encoder

Medical coding software

Job description

Position: IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst

Duration: 12 Months- with extension

Location: 1201 Main Street Suite 600, Columbia, SC- 29201

Special Requirements

Work Location: 80% remote, resources will need to come onsite in Columbia, SC to certain trainings/meetings

Candidate Location: Resource can reside anywhere in the US - must be willing to travel onsite to Columbia, SC within notice from management at the resources expense.

Strong preference for resources that are local to SC, NC, or GA.

This position requires an individual with strong analytical skills and experience in:

Managing multiple work efforts simultaneously

Medical Coding

Clinical background not required but could be beneficial

Time management skills

CPT/HCPCS and ICD-10 translation knowledge and ability to learn how medical codes link to claims processing

Ability to understand business and functional requirements

Please ensure that candidates have strength in these areas.

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 degree to align with healthcare environment

Position Description

The State of South Carolina is looking for an IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst

Why is this position open: new position - The position we are seeking to fill is for a candidate with a background in healthcare and is a Certified Medical Coder.

Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive.

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

Scope Of The Project

This project is a multi-year-old effort which primarily focuses on providing consulting services to operations and policy staff for the current Medicaid Management Information System (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 apply 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 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

Required Education

Other project-related duties, as assigned or required

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).

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)