About this position
Business Analyst - Advanced
OBJECTIVES TO BE FULFILLED BY CANDIDATE:
The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. As the IT Healthcare Consultant – Business Analyst – Advanced (Clinical Analyst and Coding Specialist):
Specific duties include, but are not limited to:
- Initiates annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
- Performs initial review of codes to determine scope of changes.
- Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis.
- Conducts meetings with Agency personnel, stakeholders, and process owners.
- (Future) Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
- Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
- Research business rules, requirements, and models to complete initial analysis and recommendations.
- Maintains business rules, requirements, and models in a repository.
- Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
- May serve as a back-up to review patient records against established criteria to determine medical necessity.
- Other project-related duties.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
- 5+ years in healthcare insurance; medical review, program integrity, or appeals.
- 5+ years working with IT developers/programmers in a payor environment.
- 5+ years Medical Coding in payer environment.
- 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
- 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
- 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.
ADDITIONAL SKILLS:
- 5+ years written and oral communications skills, strong proficiency in English.
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
- 5+ years’ experience in policy remediation.
- 5+ years claims processing systems experience.
- 5+ years knowledge of Microsoft Office
- 5+ years Optum Encoder and/or other medical coding software programs
REQUIRED EDUCATION:
- Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
REQUIRED CERTIFICATIONS:
- Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
- Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.
Benefits at IntelliBee
- Long-Term Stability: Join us on a multi-year opportunities with room to grow.
- Comprehensive Health Coverage: Access quality healthcare benefits to keep you and your family well.
- Future Planning: Enroll in our 401(k) program and invest in your financial security.
- GC Assistance: We support immediate Green Card processing, if required.
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