What are the responsibilities and job description for the Remote RN Business Analyst position at Cambay Healthcare LLC?
Job Description
Remote RN Business Analyst
Location: Fully Remote (Candidate must reside in South Carolina)
Shift: 08 hour Day Shift
Duration: 12 Months (Possible Extension)
Pay range: $44/hr - $50/hr DOE
Guaranteed Hours: 40 hours per week
Interview Process: 1 Round – Virtual/Online
Employment Type: Contract
Work Authorization: Green Card or EAD preferred
Job Overview
We are seeking an experienced IT Healthcare Consultant – Business Analyst (Advanced) to support the South Carolina Department of Health and Human Services (SCDHHS), the State Medicaid Agency.
This role focuses on medical coding analysis, healthcare policy support, and claims-related research, rather than direct coding. The candidate will serve as a Clinical Analyst and Coding SME, supporting Medicaid program operations and system enhancements.
Key Responsibilities
- Review and analyze ICD-10, CPT, and HCPCS coding changes from CMS
- Evaluate coding updates and determine business impact
- Prepare documentation and reports for Medicaid policy and operations teams
- Collaborate with stakeholders, IT teams, and program staff
- Support Medicaid Management Information System (MMIS) enhancements
- Provide subject matter expertise in medical coding and healthcare policy
- Analyze claims and coding data to support recommendations
- Participate in process improvement and system modernization initiatives
- Maintain business rules, requirements, and documentation repositories
- Support meetings with internal teams and stakeholders
- Assist in research and analysis of healthcare regulations and policies
- May support medical necessity reviews as needed
Required Qualifications
- Active Registered Nurse (RN) license – South Carolina required
- CPC or CCS certification (active preferred or achievable within 1 year)
- Bachelor’s or Associate Degree in Nursing (BSN/ADN)
- 3 years clinical nursing experience
- 5 years healthcare insurance / payer experience
- 5 years experience with medical coding in payer environment
- Strong knowledge of ICD-10, CPT, HCPCS
- Strong understanding of anatomy, physiology, and medical terminology
- Experience working with IT teams or developers in healthcare environment
- Experience in claims, utilization review, or appeals
Pay: $44.00 - $46.00 per hour
Experience:
- healthcare insurance, medical review, program integrity: 5 years (Required)
- Registered nurse : 3 years (Required)
License/Certification:
- CPC (Required)
- RN South Carolina (Required)
Work Location: On the road
Salary : $44 - $46