IT Healthcare Consultant Business Analyst

VIVA USA Inc; Columbia (SC); Hybrid; USD 80,000 - 120,000; Full time

Benefits offered by this job

Remote work

Onsite trainings

Equal opportunity employer

Job summary

VIVA USA Inc. seeks an IT Healthcare Consultant - Business Analyst - Advanced (Clinical Analyst and Coding Specialist) to support Medicaid MMIS coding and policy work, focusing on CPT/HCPCS and ICD-10 updates. Remote work is available 80% with onsite trainings in Columbia, SC.

The role requires healthcare experience, coding proficiency, and strong documentation skills; you will liaison with CMS and internal teams, maintain coding rules, and prepare change listings for review.

Qualifications

• 3+ years’ experience in healthcare industry.
• Strong knowledge of CPT/HCPCS translation and coding.
• 3+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.
• 3+ years experience in formal business process documentation.

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 client personnel, stakeholders, and process owners.
• May participate in DASH project meetings where reference administration expertise is required.
• Serves as an client 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 to ensure process documentation is complete, owner and stakeholder training content is complete and routinely updated.
• May serve as a back-up to other roles within the bureau to support claim escalations research.
• Other project-related duties, as assigned or required

Skills

Healthcare experience

CPT/HCPCS coding

Anatomy knowledge

Business process docs

Education

Bachelor’s degree in healthcare

Tools

Microsoft Office

Optum Encoder

Medical coding software

Job description

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

The clientis looking for an IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst

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 withclient personnel, stakeholders, and process owners.
• (Future) Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
• Serves as anclient 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

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)

REQUIRED EDUCATION

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

REQUIRED CERTIFICATIONS

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

ADDITIONAL SKILLS / Notes

Written and oral communications skills, strong proficiency in English

Ability to effectively communicate with executive management, line management, project management, and team members

Notes

80% remote, resources will need to come onsite

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status