Senior Business Analyst Consultant (Medicaid | MMIS | Medical Coding SME)

🔹 Job TitleSenior Business Analyst Consultant (Medicaid | MMIS | Medical Coding SME)📍 LocationFully Remote(Candidate must currently reside in South Carolina – No relocation allowed)💼 Employment TypeW2 Contract (12 Months – Extension Possible)💼Experience: 12+ years minimum Note: Only USC, GC and EAD's Eligible, do not apply H1B holders please!🧾 About the RoleWe are seeking a Senior Business Analyst Consultant with deep expertise in Medicaid systems, MMIS, and medical coding to support a State Government healthcare initiative.This is a high-impact, SME-level role responsible for managing medical coding updates, policy compliance, and MMIS system enhancements. The ideal candidate will ensure that system changes align with federal (CMS) regulations and result in accurate claims adjudication outcomes for Medicaid members and providers.⚠️ This is NOT a generic Business Analyst role. Candidates must have strong payer-side healthcare experience and hands-on medical coding expertise.🔹 Key ResponsibilitiesAnalyze and manage CPT, HCPCS, and ICD-10 coding updates (quarterly & annual CMS releases)Support enhancements and issue resolution within MMIS (Medicaid Management Information System)Perform impact analysis of coding and policy changes on claims adjudicationGather, define, and document business and functional requirementsDevelop and maintain business rules, workflows, and process documentationAct as a Subject Matter Expert (SME) for medical coding methodologies and Medicaid policyCollaborate with policy teams, stakeholders, and IT developers to ensure accurate implementationFacilitate meetings, workshops, and stakeholder discussionsEnsure compliance with state and federal healthcare regulationsSupport process improvement initiatives and system modernization efforts🔹 Required Qualifications12+ years of experience in healthcare, with strong focus on payer-side insurance (Medicaid preferred)Hands-on experience with MMIS (Medicaid Management Information System)Strong expertise in medical coding: CPT, HCPCS, ICD-10Experience with claims processing and adjudication workflowsProven experience in business analysis (requirements gathering, business rules, impact analysis)Experience working with IT teams (developers, system teams)Strong analytical, problem-solving, and communication skillsAbility to manage multiple priorities in a fast-paced environment🔹 Preferred QualificationsExperience in Medicaid policy, compliance, or remediation projectsExperience working with government healthcare programs or managed care organizationsKnowledge of medical claims processing systemsFamiliarity with tools such as Microsoft Office, Optum Encoder, or similar coding softwareClinical background or experience working with healthcare providers (preferred)EducationBachelor’s degree in Healthcare Administration, Health Information Management, or related fieldEquivalent experience will be considered🔹 Key SkillsMedicaid · MMIS · CPT · HCPCS · ICD-10 · Claims Adjudication · Healthcare Business Analysis · Policy & Compliance · Business Rules · Stakeholder Management · Process Improvement⚠️ Important NotesOnly candidates currently residing in South Carolina will be consideredMust have hands-on Medicaid, MMIS, and medical coding experienceProfiles from property & casualty insurance, underwriting, or provider-side hospital coding will NOT be consideredWhy JoinWork on impactful State Medicaid initiativesOpportunity to act as a Subject Matter Expert (SME)Collaborative, mission-driven environmentLong-term engagement with potential extensionInterested?Apply with your updated resume highlighting your MMIS, Medicaid, and medical coding experience.