Business Analyst with Clinical Analyst & Coding

Job Title: IT Healthcare Consultant – Business Analyst - Advanced (Clinical Analyst & Coding Specialist)Location: Columbia, SC (Fully Remote – Candidate must reside in South Carolina)Duration: 12 Months (Possible Extension)Interview Process: 1 Round – Virtual/OnlineKey ResponsibilitiesInitiate annual and quarterly ICD-10, CPT, and HCPCS coding updates from CMSReview and analyze coding changes to determine business and operational impactsPrepare code change listings for Reference Administration and Medicaid Program teamsConduct meetings with agency personnel, stakeholders, and process ownersServe as SME for medical coding methodologies and Medicaid policyResearch business rules, requirements, and models to provide recommendationsMaintain business rules and documentation repositoriesCollaborate with teams to ensure documentation and training materials are updatedParticipate in MMIS enhancement and future replacement initiativesSupport medical necessity reviews when requiredAssist with process improvement initiatives and project-related activitiesRequired SkillsBachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)Active, unrestricted South Carolina Registered Nurse (RN) licenseCPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certificationICD-10 proficiency certification or ability to obtain within one year5+ years healthcare insurance experience (medical review, appeals, or program integrity)5+ years working with IT developers/programmers in a payer environment5+ years medical coding experience in payer environment3+ years clinical healthcare experience with strong assessment skills5+ years knowledge of ICD/CPT/HCPCS coding methodologiesStrong understanding of anatomy, physiology, pharmacology, and medical terminologyStrong analytical, communication, collaboration, and relationship-building skillsExperience managing multiple work efforts simultaneouslyAbility to write and understand business and functional requirementsPreferred Skills5+ years policy remediation experience5+ years claims processing systems experienceExperience with Optum Encoder and other medical coding software programsGovernment operations and managed care background preferredAdditional InformationFully Remote role; however, candidate must currently reside in South CarolinaNo relocation permitted