Clinical Analyst & Coding SME — Hybrid (80% Remote)

Sunshine Enterprise USA LLC; Columbia (SC); Hybrid; USD 90,000 - 130,000; Part time

Benefits offered by this job

Hybrid work model

Job summary

Sunshine Enterprise USA LLC seeks a Clinical Analyst & Coding Specialist in Columbia, SC. The role is hybrid (80% remote) with onsite trainings and meetings. It is a 12-month contract requiring 10+ years in healthcare insurance, medical review, and coding, with RN license and CPC/CCS certifications.

The consultant will serve as an SME for medical coding, Medicaid policy, and business analysis, supporting coding updates, policy implementations, and process improvements across teams.

Qualifications

• 10+ years of experience in healthcare insurance, medical review, program integrity, or appeals.
• 5+ years working with IT developers/programmers in a payer environment.
• 5+ years of medical coding experience in a payer environment.
• 3+ years of clinical experience in a healthcare environment.

Responsibilities

• Coordinate ICD-10, CPT, and HCPCS code updates annually and quarterly.
• Review coding changes for business and operational impact.
• Prepare code change documentation for stakeholder review.
• Collaborate with business users, stakeholders, and technical teams on coding and policy updates.
• Participate in healthcare systems modernization meetings.

Skills

Analytical skills

Stakeholder management

Communication

Healthcare payer domain

Education

BSN/ADN

Tools

Optum Encoder

Coding software

Job description

Sunshine Enterprise USA LLC seeks a Clinical Analyst & Coding Specialist in Columbia, SC. The role is hybrid (80% remote) with onsite trainings and meetings. It is a 12-month contract requiring 10+ years in healthcare insurance, medical review, and coding, with RN license and CPC/CCS certifications.

The consultant will serve as an SME for medical coding, Medicaid policy, and business analysis, supporting coding updates, policy implementations, and process improvements across teams.