IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst

Summary

Intellectual Capitol (ICAP) is seeking an IT Healthcare Consultant and Advanced Business Analyst to support Medicaid operations and policy staff for a Medicaid Management Information System. The role serves as a medical coding subject matter expert, maintains CPT/HCPCS and ICD-10 code references, analyzes business requirements, and supports documentation, stakeholder collaboration, and training.

Responsibilities

• 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 other roles within the bureau to support claim escalations research, once the person has demonstrated full proficiency in the job functions required for their new role
• Other project-related duties, as assigned or required

Skills

• A candidate with a background in healthcare and is a Certified Medical Coder
• Strong analytical skills
• Managing multiple work efforts simultaneously
• Medical Coding
• Time management skills
• CPT/HCPCS and ICD-10 translation knowledge and ability to learn how medical codes link to claims processing
• Ability to understand business and functional requirements
• The candidate must have strong collaboration and relationship building skills
• Experience in healthcare or degree to align with healthcare environment
• 3+ years' experience in healthcare
• Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
• 3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
• 3+ years of strong knowledge of formal business process documentation
• Bachelor's degree in healthcare related field
• An equivalent combination of experience and education may be considered with prior Agency hiring team review and approval
• Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist)
• Written and oral communications skills, strong proficiency in English
• Ability to effectively communicate with executive management, line management, project management, and team members
• Clinical background
• Candidates with hospital, office, or clinic settings experience
• 3+ years' experience healthcare hospital, office and clinic setting
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)

Qualifications

Must Haves

• a candidate with a background in healthcare and is a Certified Medical Coder
• strong analytical skills
• Managing multiple work efforts simultaneously
• Medical Coding
• Time management skills
• CPT/HCPCS and ICD-10 translation knowledge and ability to learn how medical codes link to claims processing
• Ability to understand business and functional requirements
• The candidate must have strong collaboration and relationship building skills
• Experience in healthcare or degree to align with healthcare environment
• 3+ years' experience in healthcare
• Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
• 3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
• 3+ years of strong knowledge of formal business process documentation
• Bachelor's degree in healthcare related field
• An equivalent combination of experience and education may be considered with prior Agency hiring team review and approval
• Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist)
• Written and oral communications skills, strong proficiency in English
• Ability to effectively communicate with executive management, line management, project management, and team members

Nice to Haves

• Clinical background
• Candidates with hospital, office, or clinic settings experience
• 3+ years' experience healthcare hospital, office and clinic setting
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)

Benefits

• 80% remote work arrangement
• Resources can reside anywhere in the US, subject to onsite attendance in Columbia, SC for certain trainings and meetings
• Video conferencing available for interviews