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