Job Description

Job Title: Healthcare Business Analyst
Job Location: South Carolina


  • 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 and other affected parties
  • Serves as a team expert on Medical Coding methodologies, Medicaid Policy and related topics
  • Researches business rules, requirements, and models
  • Maintains business rules, requirements, and models in a repository

Required Qualifications:

  • Fifteen years of experience in healthcare insurance; medical review, program integrity, or appeals
  • Five years of experience working with IT developers/programmers in payer environment
  • Five years of experience Medical Coding in payer environment
  • Strong knowledge of ICD/CPT/HCPCS translation
  • Strong knowledge of ICD/CPT/HCPCS coding methodologies
  • Extensive knowledge of anatomy, physiology, pharmacology and medical terminology
  • Superb written and oral communications skills, strong proficiency in English
  • Strong knowledge of formal business process documentation
  • Ability to effectively communicate to executive management, line management, project management, and team members

Preferred Qualifications:

  • RN or LPN/Medical Coding Certification
  • Current nursing license in South Carolina
  • Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist)
  • ICD-10 proficiency demonstrated by exam
  • Experience in policy remediation
  • Claims processing systems experience
  • Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and or other medical coding software programs)

QBH#: 2157

Application Instructions

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