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IT Healthcare Consultant – Business Analyst (Clinical Analyst & Coding Specialist) - BA 26-05744

NavitasPartners

Columbia, SC(remote)

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JOB DETAILS
SKILLS
Analysis Skills, Anatomy, Business Analysis, Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Claims Processing, Clinical Assessment, Code Reviews, Communication Skills, Content Development, Current Procedural Terminology (CPT), Documentation, Health Information Technology, Health Insurance, Healthcare, Healthcare Common Procedure Coding System (HCPCS), ICD-10, Information Technology Consulting, International Classification of Diseases (ICD), Maintain Compliance, Medicaid, Medical Assistance, Medical Coding, Medical Terminology, Microsoft Office, Nursing, Operations Management, Pharmacology, Physiology, Presentation/Verbal Skills, Registered Nurse (RN), Systems Maintenance, Team Player, Training/Teaching Materials, Writing Skills
LOCATION
Columbia, SC
POSTED
Today

Job Title: IT Healthcare Consultant – Business Analyst (Clinical Analyst & Coding Specialist)
Location: Fully Remote
Job Type: Contract (12 Months)

Job Overview: We are seeking an experienced IT Healthcare Consultant / Business Analyst with strong expertise in clinical analysis and medical coding. This role will focus on maintaining and updating coding systems, supporting Medicaid-related processes, and collaborating with stakeholders to ensure compliance and operational efficiency.

Key Responsibilities:

  • Manage and implement ICD-10, CPT, and HCPCS code updates (annual and quarterly)
  • Review and analyze coding changes to determine business impact
  • Prepare and present code change documentation for stakeholders
  • Conduct meetings with internal teams, stakeholders, and process owners
  • Act as Subject Matter Expert (SME) for medical coding and healthcare policies
  • Research and document business rules, requirements, and models
  • Maintain documentation repositories and ensure process updates
  • Support training content development and updates
  • Assist with medical necessity reviews when required
  • Participate in system/project meetings related to healthcare systems

Required Qualifications:

  • 5+ years of experience in healthcare insurance (medical review, program integrity, or appeals)
  • 5+ years of experience working with IT teams in a payer environment
  • 5+ years of medical coding experience in a payer environment
  • 3+ years of clinical healthcare experience
  • Strong knowledge of ICD, CPT, and HCPCS coding methodologies
  • Strong understanding of anatomy, physiology, pharmacology, and medical terminology
  • Excellent written and verbal communication skills
  • Proficiency in Microsoft Office Suite

Preferred Qualifications:

  • Experience in policy remediation
  • Experience with claims processing systems
  • Experience with coding tools such as Optum Encoder or similar

Education Requirements:

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

Certifications Required:

  • Active, unrestricted Registered Nurse (RN) license
  • CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification
  • ICD-10 certification (or ability to obtain within 1 year)

For more details reach at resumes@navitassols.com.

About the Company

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NavitasPartners