Business Analyst

The role is well suited for a healthcare professional with strong medical coding knowledge who enjoys working on complex, change-oriented projects and collaborating with policy owners, stakeholders, and project teams. This role combines healthcare business analysis, medical coding expertise, and process documentation to support CPT/HCPCS and ICD-10 code maintenance and related healthcare process improvements.

Senior Healthcare Business Analyst – Medical Coding (CPC/CCS)

Position Overview

This role combines healthcare business analysis, medical coding expertise, and process documentation to support CPT/HCPCS and ICD-10 code maintenance and related healthcare process improvements. The position serves as a subject matter expert in medical coding methodologies and supports research, analysis, recommendations, stakeholder collaboration, and ongoing business process documentation.

The role is well suited for a healthcare professional with strong medical coding knowledge who enjoys working on complex, change-oriented projects and collaborating with policy owners, stakeholders, and project teams.

What You'll Do

• Initiate annual and quarterly updates from CMS covering ICD-10 and CPT/HCPCS coding changes.

• Perform initial reviews of codes to determine the scope of changes.

• Prepare listings of code changes for Reference Administration staff and Medicaid Program staff for review and analysis.

• Conduct meetings with agency personnel, stakeholders, and process owners.

• Participate in project meetings, as needed, where reference administration expertise is required.

• Serve as a subject matter expert for medical coding methodologies, Medicaid policy, and related topics.

• Research business rules, requirements, and models to complete initial analysis and recommendations.

• Maintain business rules, requirements, and models in a repository.

• Collaborate with the team to ensure process documentation is complete.

• Support the completion and routine updating of training content for owners and stakeholders, as needed.

• May serve as a backup to other roles within the bureau to support claim escalation research after demonstrating full proficiency in the required job functions.

• Perform other project-related duties as assigned or required.

Required Qualifications

• Bachelor’s degree in a healthcare-related field.

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

• 3+ years of experience in healthcare.

• Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.

• 3+ years of extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.

• 3+ years of strong knowledge of formal business process documentation.

• Strong analytical skills.

• Ability to manage multiple work efforts simultaneously.

• Ability to understand business and functional requirements.

• Strong collaboration and relationship-building skills.

• Ability to understand CPT/HCPCS and ICD-10 translation and how medical codes link to claims processing.

An equivalent combination of experience and education may be considered with prior hiring team review and approval.

Preferred Qualifications

• 3+ years of healthcare experience in hospital, office, and clinic settings.

• Knowledge of Microsoft Office, including Word, Excel, and PowerPoint.

• Knowledge of Optum Encoder and other medical coding software programs.

• Clinical background.

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