IT Healthcare Consultant - Business Analyst - Advanced

Datasoft Technologies, Inc.; New York (NY); Hybrid; USD 96,000 - 165,000; Full time

Job summary

DataSoft Technologies is seeking an IT Healthcare Consultant - Business Analyst - Advanced to support Medicaid MMIS coding and policy tasks in a hybrid role based in Columbia, SC. You will act as SME for CPT/HCPCS and ICD-10 coding, and help staff apply codes correctly within Reference Administration.

Preferred candidates have 3+ years in healthcare coding and strong business process documentation skills, plus proficiency with Microsoft Office and coding software like Optum Encoder.

Qualifications

• Bachelor’s degree in healthcare or a related field.
• 3+ years of healthcare experience with ICD-10, CPT/HCPCS coding.
• Strong knowledge of formal business process documentation.

Responsibilities

• Maintain CPT/HCPCS and ICD-10 code sets and updates.
• Review CMS ICD-10/CPT code changes and prepare impact listings.
• Collaborate with CMS, Reference Administration staff, and stakeholders.
• Serve as SME for medical coding and Medicaid policy.

Skills

CPT/HCPCS coding

ICD-10 coding

Process documentation

Education

Bachelor's degree in healthcare

Tools

Microsoft Office

Optum Encoder

Job description

IT Healthcare Consultant - Business Analyst - Advanced

Hybrid: Columbia, SC

About the Job

• Duration: Long term Contract Position
• Location: Hybrid: Columbia, SC
• Pay rate: Hourly
• Job ID: 13856

Overview:

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.

Essential Responsibilities:

• 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/HCPC 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 Knowledge/Skills:

• 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 Requirements/Skills:

• 3+ years' experience healthcare hospital, office and clinic setting
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
• Other: preference for resources that are local to SC, NC, or GA. Resources can reside anywhere in the US -- but must be willing to travel onsite to Columbia, SC within notice from management at the resources expense

REQUIRED EDUCATION:

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

REQUIRED CERTIFICATIONS:

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

Additional Skills:

• Written and oral communications skills, strong proficiency in English
• Ability to effectively communicate with executive management, line management, project management, and team members

About our Company

DataSoft Technologies is a highly recognized provider of professional IT Consulting services in the US. Founded in 1994, DataSoft Technologies, Inc. provides staff augmentation services for Information Technology and Automotive Services. Our team member benefits include:

• Paid Holidays/Paid Time Off (PTO)
• Medical/Dental Insurance Group
• Accident/Critical Illness Insurance
• Life Insurance
• 401 (K)