Systems Software Programmer Consultant

InterSources Inc.

Columbia, SC

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JOB DETAILS

SKILLS

Anatomy, Artificial Intelligence (AI), Business Analysis, Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Claims Processing, Clinical Assessment, Cloud Applications, Code Reviews, Computer Programming, Consulting, Content Management Systems (CMS), Current Procedural Terminology (CPT), Data Analysis, Documentation, ERP (Enterprise Resource Planning), 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, Medicaid, Medical Assistance, Medical Coding, Medical Terminology, Microsoft Office, Online Marketing, Pharmacology, Physiology, Quality Assurance, Registered Nurse (RN), Software Development, Software Engineering, Statement of Work (SOW), System Integration (SI), Systems/Internals Programming, User Experience Design (UXD), User Interface Design, Web Programming

LOCATION

Columbia, SC

POSTED

4 days ago

Job Title: IT Healthcare Consultant – Business Analyst – Consultant (12771)
Location: Columbia, SC 29201
Work Arrangement: Hybrid – approximately 80% remote; onsite for required training and meetings
Candidate Location:Must be a current South Carolina resident. No relocation allowed.
Contract: 12 Months, with possible extension
Interview: 1 Round – Virtual/Online
Status: Rebid

Job Overview: The consultant will serve as a medical coding SME, supporting CPT/HCPCS and ICD-10 code maintenance, researching coding changes, analyzing business rules, working with Medicaid program stakeholders, and supporting current and future MMIS enhancements. The SOW specifically identifies this position as being focused on a Certified Medical Coder supporting South Carolina Medicaid.
Key Responsibilities

Manage annual and quarterly ICD-10 and CPT/HCPCS coding updates from CMS.
Review coding changes and determine their impact on Medicaid policies and processes.
Prepare code-change documentation for Medicaid program and reference administration teams.
Serve as an SME for medical coding methodologies, Medicaid policy, and healthcare processes.
Research and document business rules, requirements, and recommendations.
Collaborate with policy owners, stakeholders, IT developers, and project teams.
Support MMIS enhancements and future MMIS replacement/DASH initiatives.
Assist with medical necessity reviews when required.

Required Qualifications

BSN or ADN required.
Current, active, unrestricted South Carolina Registered Nurse license – mandatory.
Current CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential.
ICD-10 proficiency demonstrated by exam, or ability to obtain certification within one year.
10+ years healthcare insurance experience involving medical review, program integrity, or appeals.
5+ years working with IT developers/programmers in a payer environment.
5+ years medical coding experience in a payer environment.
3+ years clinical healthcare experience with strong clinical assessment and critical-thinking skills.
5+ years knowledge of ICD/CPT/HCPCS coding and translation methodologies.
5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.

Preferred Skills

5+ years policy remediation experience.
5+ years claims processing systems experience.
5+ years Microsoft Office experience.
5+ years with Optum Encoder or similar medical coding software.

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,

About the Company

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/

Systems Software Programmer Consultant

InterSources Inc.

Columbia, SC

About the Company

InterSources Inc.

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