Clinical Analyst # 26-24847

NurseRemotely; United States; Remote; USD 90,000 - 115,000; Full time

Job summary

US Tech Solutions is seeking an IT Healthcare Consultant – Advanced (Clinical Analyst and Coding Specialist) to maintain ICD-10, CPT/HCPCS coding changes and support Medicaid policy analyses. The role focuses on coding accuracy, process documentation, and stakeholder collaboration.

Remote work is available for candidates nationwide; travel to Columbia, SC will be required for trainings and meetings. A CPC or CCS credential and a healthcare background are essential.

Qualifications

• Bachelor’s degree in a healthcare related field is required or equivalent experience considered with approval.
• Credentialing CPC or CCS is required.
• 3+ years of healthcare experience and coding methodologies knowledge.
• Proven ability to document formal business processes.

Responsibilities

• Initiates annual and quarterly ICD-10, CPT/HCPCS updates from CMS.
• Reviews codes to determine scope of changes and prepares change listings.
• Coordinates with Reference Administration and Medicaid staff for review.
• Leads meetings with agency personnel and stakeholders.
• Acts as SME for medical coding methodologies and Medicaid policy.
• Documents business rules and models; maintains repository content.
• Ensures training materials are complete and up to date.
• May back-up other roles to support claim escalations as needed.

Skills

Healthcare experience

ICD/CPT/HCPCS translation

Anatomy/Physiology/Pharmacology

Business process documentation

Education

Bachelor’s degree in healthcare related field

Tools

Microsoft Office

Optum Encoder

Medical coding software

Job description

Duration: 12 Months

Summary: 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):

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 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
• Other project-related duties, as assigned or required

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

Required education

• Bachelor’s degree in healthcare related field. An equivalent combination of experience and education may be considered with prior department hiring team review and approval.

Required certifications

• Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).

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)

Location

Remote – Columbia, SC (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.

About US Tech Solutions

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com. US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

AI Statement

By applying, you acknowledge that AI-assisted tools may be used during hiring.

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