Position Details: Nursing Business Analyst

Description:

Position:  Nursing Business Analyst - #10952
Client: State of SC (DHHS)
Location: Columbia, SC 29210
Duration: 12+ months with probable extension

Green Card and US Citizens only!

SCOPE OF THE PROJECT:
This project is a multi-year effort which primarily focuses on providing consulting services to operations and policy staff for the current 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. A long-term plan includes participating and providing guidance in the administrative approach for the replacement management system. It is necessary to build and sustain a strong Medical Coding 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.

OBJECTIVES TO BE FULFILLED BY CANDIDATE:
The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance.

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.
• Researches 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.
• Other project-related duties.

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Five years’ experience in healthcare insurance; medical review, program integrity, or appeals.
• 5 years’ experience working with IT developers/programmers in a payor environment.
• 5 years’ 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.

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Experience in policy remediation.
• Claims processing systems experience.
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and or other medical coding software programs).
• Strong knowledge of formal business process documentation.
• Ability to effectively communicate with executive management, line management, project management, and team members.

REQUIRED EDUCATION:
RN or LPN/Medical Coding Certification

REQUIRED CERTIFICATIONS:
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.
 

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