Clinical Analyst / Medical Coding Specialist

Clinical Analyst / Medical Coding Specialist

Project Overview

This project is a multi-year-old effort which primarily focuses on providing consulting services to operations and policy staff for the current Medicaid Management Information System (MMIS).

The current position’s focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers. It is necessary to build and sustain a strong staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and applies the codes correctly within the Reference Administration sub-system.

Duties/Responsibilities:

•       Assist with ongoing CPT/HCPCS and ICD-10 code maintenance.

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

•       Review coding updates to determine the scope and impact of changes.

•       Prepare code-change listings for Reference Administration and Medicaid Program staff to review and analyze.

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

•       Participate in future DASH (Replacement MMIS) project meetings when Reference Administration expertise is required.

•       Serve as a Subject Matter Expert (SME) for medical coding methodologies, Medicaid policy, and related topics.

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

•       Maintain business rules, requirements, and models in the designated repository.

•       Collaborate with the team to maintain complete and current process documentation and training content for owners and stakeholders.

•       Provide backup support for claim escalation research after demonstrating proficiency in the required job functions.

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

Requirements

Education and Certifications:

•       Bachelor’s degree in healthcare related field. An equivalent combination of experience and education may be considered with prior experience review and approval.

•       Must be currently credentialed as either a CPC (Certified Professional Coder) or CCS (Certified Coding Specialist).

Required Skills:

•       3+ years of experience in healthcare.

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

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

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

Preferred Skills:

•       3+ years of healthcare experience in a hospital, medical office, or clinical setting.

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

•       Experience with Optum Encoder and other medical coding software programs.

•       Preference for candidates currently located in South Carolina, North Carolina, or Georgia.

•       Candidates may reside anywhere in the U.S. but must be willing to travel onsite to Columbia, SC, when requested by management, at their own expense.

Benefits