Healthcare Business Analyst - Medical Coding

Cornerstonetechtalent; Columbia (SC); Remote; USD 70,000 - 100,000; Full time

Job summary

Cornerstonetechtalent is seeking an experienced Healthcare Business Analyst – Medical Coding to support coding programs and Medicaid system initiatives within a large healthcare environment. This role blends medical coding with business analysis, focusing on CPT/HCPCS and ICD-10 maintenance, documentation, and recommendations.

The ideal candidate holds CPC or CCS, with 3+ years of healthcare experience and the ability to translate coding changes into clear requirements and documentation.

Qualifications

• CPC or CCS credential required.
• Minimum 3 years in healthcare.
• Deep knowledge of ICD-10, CPT, HCPCS coding.
• Experience documenting business processes and requirements.
• Bachelor's degree in a healthcare-related field.

Responsibilities

• Manage ICD-10 and CPT/HCPCS updates yearly or quarterly.
• Assess coding changes for scope and impact.
• Prepare coding-change documentation for stakeholders.
• Serve as SME on coding methodologies and Medicaid policy.
• Help stakeholders apply CPT/HCPCS and ICD-10 codes.
• Research business rules and develop analyses.
• Maintain process documentation in repositories.
• Facilitate meetings with stakeholders and team members.
• Support healthcare system processes requirements.
• Participate in Medicaid MMIS modernization initiatives.
• Collaborate to keep training materials up to date.
• Assist with claims-escalation research after training.

Skills

Analytical skills

Research skills

Communication skills

Documentation skills

Time management

Collaboration

Education

Bachelor's degree in healthcare-related field

Equivalent combination of education and experience

Tools

Optum Encoder

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Healthcare Business Analyst – Medical Coding Type: Long-term Contract (Potential for Extension) Location: Columbia, SC / Primarily Remote Work Setting: Approximately 80% Remote with onsite meetings and training as required

Position Overview

We are seeking an experienced Healthcare Business Analyst – Medical Coding to support medical coding, business analysis, and Medicaid system initiatives within a large healthcare environment. This position combines medical coding expertise with business analysis responsibilities and will focus heavily on CPT/HCPCS and ICD-10 code maintenance, analysis, documentation, and recommendations. The consultant will serve as a subject matter expert supporting policy and process stakeholders, ongoing Medicaid system operations and enhancements, and future system modernization initiatives. Current CPC or CCS certification is required for consideration.

Key Responsibilities

• Manage annual and quarterly updates involving ICD-10 and CPT/HCPCS coding changes.
• Review medical code changes and determine their scope and potential impact.
• Prepare coding-change documentation for program, policy, and operational stakeholders.
• Serve as a subject matter expert on medical coding methodologies, Medicaid policy, and related processes.
• Help stakeholders understand and correctly apply CPT/HCPCS and ICD-10 codes.
• Research business rules, requirements, and models and develop initial analyses and recommendations.
• Maintain business rules, requirements, and supporting documentation within established repositories.
• Facilitate meetings with business stakeholders, process owners, and other project participants.
• Support business and functional requirements associated with healthcare system processes.
• Participate in process-improvement and Medicaid system enhancement initiatives.
• Provide subject matter expertise supporting future Medicaid Management Information System (MMIS) modernization/replacement activities.
• Collaborate with team members to maintain process documentation and training materials.
• Support claims-escalation research after achieving proficiency with applicable processes.
• Manage multiple concurrent work efforts and priorities.

Required Qualifications

• Current CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential.
• 3+ years of healthcare experience.
• Strong knowledge of ICD-10, CPT, and HCPCS coding and translation methodologies.
• 3+ years of extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.
• 3+ years of experience with formal business process documentation.
• Ability to understand and document business and functional requirements.
• Strong analytical and research skills.
• Ability to manage multiple work efforts simultaneously.
• Strong time-management and organizational skills.
• Strong collaboration and relationship-building abilities.
• Strong written and verbal communication skills.
• Ability to communicate effectively with executive management, line management, project management, and technical/business team members.
• Bachelor's degree in a healthcare-related field.
• An equivalent combination of education and experience may be considered subject to approval.

Preferred Qualifications

• 3+ years of healthcare experience within a hospital, physician office, or clinical setting.
• Experience with Medicaid or other government healthcare programs.
• Experience supporting healthcare claims or understanding how medical codes affect claims processing.
• Experience with MMIS environments or healthcare system modernization initiatives.
• Clinical background or experience.
• Experience with Optum Encoder or other medical coding software.
• Proficiency with Microsoft Word, Excel, and PowerPoint.
• Candidates located in South Carolina, North Carolina, or Georgia are strongly preferred.

Ideal Candidate

The ideal candidate is a certified medical coder who also brings strong business analysis capabilities. This person should be highly knowledgeable in CPT/HCPCS and ICD-10 coding, comfortable researching and interpreting coding changes, and able to translate that information into clear recommendations, business requirements, and process documentation. Experience connecting medical coding to claims processing, Medicaid operations, or MMIS systems would be particularly relevant. The successful candidate should also be comfortable working independently, collaborating with multiple stakeholders, and managing several priorities simultaneously.

Additional Information

Position is approximately 80% remote.

Periodic onsite attendance in Columbia, SC is required for certain meetings and training.

Candidates must be able to travel onsite within management's requested notice. Onsite travel expenses are the candidate's responsibility.

Strong preference will be given to candidates located in SC, NC, or GA.

Criminal, credit, and E-Verify background checks are required.

Interview process is conducted by a team either in person or via video conferencing.