Business Analyst with Clinical Analyst & Coding

InterSources Inc is seeking an IT Healthcare Consultant with a focus on Business Analysis, specifically in Clinical Analysis and Coding. The role involves initiating coding updates, analyzing operational impacts, and collaborating with stakeholders to ensure compliance and process improvements.

Responsibilities:

• Initiate annual and quarterly ICD-10, CPT, and HCPCS coding updates from CMS
• Review and analyze coding changes to determine business and operational impacts
• Prepare code change listings for Reference Administration and Medicaid Program teams
• Conduct meetings with agency personnel, stakeholders, and process owners
• Serve as SME for medical coding methodologies and Medicaid policy
• Research business rules, requirements, and models to provide recommendations
• Maintain business rules and documentation repositories
• Collaborate with teams to ensure documentation and training materials are updated
• Participate in MMIS enhancement and future replacement initiatives
• Support medical necessity reviews when required
• Assist with process improvement initiatives and project-related activities

Requirements:

• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
• Active, unrestricted South Carolina Registered Nurse (RN) license
• CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification
• ICD-10 proficiency certification or ability to obtain within one year
• 5+ years healthcare insurance experience (medical review, appeals, or program integrity)
• 5+ years working with IT developers/programmers in a payer environment
• 5+ years medical coding experience in payer environment
• 3+ years clinical healthcare experience with strong assessment skills
• 5+ years knowledge of ICD/CPT/HCPCS coding methodologies
• Strong understanding of anatomy, physiology, pharmacology, and medical terminology
• Strong analytical, communication, collaboration, and relationship-building skills
• Experience managing multiple work efforts simultaneously
• Ability to write and understand business and functional requirements
• 5+ years policy remediation experience
• 5+ years claims processing systems experience
• Experience with Optum Encoder and other medical coding software programs
• Government operations and managed care background preferred