Clinical Analyst & Coding Specialist

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):

• 5+ years in healthcare insurance; medical review, program integrity, or appeals.

• 5+ years working with IT developers/programmers in a payor environment.

• 5+ years Medical Coding in payer environment.

• 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)

• 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.

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

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):

• 5+ years’ experience in policy remediation.

• 5+ years claims processing systems experience.

• 5+ years Optum Encoder and/or other medical coding software programs

REQUIRED EDUCATION: 

• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)

REQUIRED CERTIFICATIONS: 

• Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
• Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
• ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.