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IT Healthcare Consultant Business Analyst - Advanced (Clinical Analyst & Coding Specialist

InterSources Inc.

Columbia, SC(remote)

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JOB DETAILS
SKILLS
Analysis Skills, Anatomy, Artificial Intelligence (AI), Business Analysis, Business Operations, Business Writing, Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Claims Processing, Clinical Assessment, Cloud Applications, Cloud Computing, Code Reviews, Communication Skills, Computer Programming, Content Management Systems (CMS), Current Procedural Terminology (CPT), Data Analysis, ERP (Enterprise Resource Planning), Government, Health Information Technology, Health Insurance, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Healthcare Software, ICD-10, ISO (International Organization for Standardization), Information Technology Consulting, International Classification of Diseases (ICD), International Electro-Technical Commission (IEC), Internet Security, Managed Care, Medicaid, Medical Coding, Medical Office Administration, Medical Terminology, Nursing, Online Marketing, Oracle, Pharmacology, Physiology, Process Improvement, Quality Assurance, Registered Nurse (RN), Software Development, System Integration (SI), User Experience Design (UXD), User Interface Design, Web Programming, Writing Skills
LOCATION
Columbia, SC
POSTED
21 days ago
Job Title: IT Healthcare Consultant – Business Analyst - Advanced (Clinical Analyst & Coding Specialist) (11013)
Location: Columbia, SC (Fully Remote – Candidate must reside in South Carolina)
Duration: 12 Months (Possible Extension)
Interview Process: 1 Round – Virtual/Online
Key Responsibilities
  • Initiate annual and quarterly ICD-10, CPT, and HCPCS coding updates from CMS
  • Review and analyze coding changes to determine business and operational impacts
  • Prepare code change listings for Reference Administration and Medicaid Program teams
  • Conduct meetings with agency personnel, stakeholders, and process owners
  • Serve as SME for medical coding methodologies and Medicaid policy
  • Research business rules, requirements, and models to provide recommendations
  • Maintain business rules and documentation repositories
  • Collaborate with teams to ensure documentation and training materials are updated
  • Participate in MMIS enhancement and future replacement initiatives
  • Support medical necessity reviews when required
  • Assist with process improvement initiatives and project-related activities
Required Skills
  • Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
  • Active, unrestricted South Carolina Registered Nurse (RN) license
  • CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification
  • ICD-10 proficiency certification or ability to obtain within one year
  • 5+ years healthcare insurance experience (medical review, appeals, or program integrity)
  • 5+ years working with IT developers/programmers in a payer environment
  • 5+ years medical coding experience in payer environment
  • 3+ years clinical healthcare experience with strong assessment skills
  • 5+ years knowledge of ICD/CPT/HCPCS coding methodologies
  • Strong understanding of anatomy, physiology, pharmacology, and medical terminology
  • Strong analytical, communication, collaboration, and relationship-building skills
  • Experience managing multiple work efforts simultaneously
  • Ability to write and understand business and functional requirements
Preferred Skills
  • 5+ years policy remediation experience
  • 5+ years claims processing systems experience
  • Experience with Optum Encoder and other medical coding software programs
  • Government operations and managed care background preferred
Additional Information
  • Fully Remote role; however, candidate must currently reside in South Carolina
  • No relocation permitted
About Us:
InterSources Inc , is a Small, Woman, and Minority-Owned Business Enterprise, ISO/IEC 27001, SOC 2 Type 2 certified company with massive 18+ years of diversified experience in providing IT Consulting Services, Artificial Intelligence, Data Analysis, Application Development, Cloud Services, Cybersecurity, Digital Marketing, ERP Management, Custom Software Development, Web Development, UI/ UX Design, System Integration, QA Support etc. We make reasonable accommodations for clients and employees, and we do not discriminate based on any protected attribute including race, religion, color, national origin, gender sexual orientation, gender identity, age, or marital status. We also are a Google Cloud and Oracle partner company.

About the Company

I

InterSources Inc.

It’s all about harnessing the real power of data. InterSources Inc was founded in 2007 providing intelligent data solutions to clients across industries and geographies.

Over the years, we have built products on Business Intelligence & Big Data platform simplifying and transforming the way business intelligence and real-time data analytics empower Corporations and end-users using Softwares like Tableau, Business Objects, MicroStrategy, etc.

In the process, we have enabled companies to use data analytics to help better understand, predict and influence consumer behavior, identify new market opportunities as they emerge, provide to users the data they need, alert the user when and why key business metrics have changed and enable them to make smart decisions.

COMPANY SIZE
100 to 499 employees
INDUSTRY
Computer/IT Services
FOUNDED
2007
WEBSITE
https://www.intersourcesinc.com/