Senior Healthcare IT & Coding Analytics Consultant

Talent Software Services; Columbia (SC); On-site; USD 65,000 - 90,000; Full time

Job summary

The South Carolina Department of Health & Human Services (SCDHHS) seeks a qualified healthcare professional with CPC or CCS certification to support medical code changes within the current MMIS framework. The role emphasizes research, policy input, and collaboration with policy owners and stakeholders.

Responsibilities include reviewing and initiating code changes, preparing change listings for review, and participating in project meetings (including DASH).

Qualifications

• 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

Responsibilities

• Initiating annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes
• Performing initial review of codes to determine the scope of changes
• Preparing listings of code changes for Reference Administration staff and Medicaid Program staff for review and analysis
• Conducting meetings with Agency personnel, stakeholders, and process owners
• Participating in DASH (Replacement MMIS) project meetings, as needed
• Serving as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics
• Researching business rules, requirements, and models to complete initial analysis and recommendations
• Maintaining business rules, requirements, and models in a repository
• Collaborating with the team to ensure process documentation is complete and training content is updated
• Serving as a back-up to other roles within the bureau to support claim escalations research, once proficiency is demonstrated

Job description

The South Carolina Department of Health & Human Services (SCDHHS) seeks a qualified healthcare professional with CPC or CCS certification to support medical code changes within the current MMIS framework. The role emphasizes research, policy input, and collaboration with policy owners and stakeholders.

Responsibilities include reviewing and initiating code changes, preparing change listings for review, and participating in project meetings (including DASH).