IT Healthcare Consultant

The IT Healthcare Consultant – Advanced Business Analyst (Clinical Coding Specialist) supports the South Carolina Department of Health & Human Services (SCDHHS) in maintaining and enhancing Medicaid Management Information System (MMIS) operations. This role serves as a subject matter expert in medical coding methodologies, Medicaid policy, and payer -based system environments. The consultant leads analysis and implementation of CMS -driven coding updates, translates regulatory requirements into actionable business rules, and collaborates closely with IT development teams and policy stakeholders. This is a consultative, systems -focused role that supports ongoing modernization initiatives, regulatory compliance, and operational continuity within a complex Medicaid payer environment.

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• Initiate and manage annual and quarterly CMS updates for ICD -10, CPT, and HCPCS codes.

• Perform impact analysis of coding changes and determine operational and system implications.

• Translate regulatory and coding updates into business rules, functional requirements, and system specifications.

• Prepare and distribute code change documentation to reference administration and Medicaid program staff.

• Conduct stakeholder meetings with agency personnel, process owners, and cross -functional teams.

• Serve as subject matter expert for medical coding methodologies, Medicaid policy, and related regulatory guidance.

• Maintain business rules, requirements, and reference documentation repositories.

• Collaborate with IT developers and programmers to support MMIS enhancements and future MMIS replacement initiatives.

• Contribute to process improvement efforts across claims and reference administration functions.

• Provide backup support for medical necessity reviews as needed.

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• 5 years of experience in a healthcare insurance payer environment (medical review, program integrity, or appeals).

• 5 years of medical coding experience within a payer environment.

• 5 years of collaboration with IT developers or programmers in a payer -based system environment.

• 5 years of experience with ICD -10, CPT, and HCPCS coding methodologies.

• 3 years of clinical experience in a healthcare setting with strong assessment and critical thinking skills.

• Strong knowledge of anatomy, physiology, pharmacology, and medical terminology.

• Experience translating business rules into system or technical requirements.

• Strong written and verbal communication skills in English.

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• Experience in policy remediation initiatives.

• Experience with claims processing systems.

• Experience with MMIS platforms and MMIS replacement initiatives.

• Familiarity with Optum Encoder or similar medical coding software.

• Experience supporting enterprise system modernization efforts.

• Advanced proficiency in Microsoft Office applications.

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• Must be a current resident of South Carolina; relocation is not permitted.

• Subject to State mandatory Criminal, Credit, and E -Verify background checks.

• Participation in a one -round virtual interview process.

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Location: Columbia, South Carolina

Schedule: Standard business hours (specific schedule to be determined by the agency)

Work Arrangement: Hybrid - approximately 20% onsite

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Air InfoSec offers an Individual Coverage Health Reimbursement Arrangement (ICHRA), providing up to $350/month in tax -free reimbursements to help cover the cost of your own health insurance premium. This gives you the flexibility to choose the plan that works best for you and your family.

1 hour of PTO earned for every 20 hours worked.

Can carryover up to 5 days of PTO to the next calendar year.

5 paid state holidays (annually)

2 paid floating holidays (annually)

$100 per year to apply towards annual certification fees or educational training.