What are the responsibilities and job description for the Healthcare Business Analyst position at CornerStone Technology Talent Services?
Overview
We are seeking a Senior Healthcare Business Analyst with strong experience in healthcare insurance, medical coding, and clinical analysis to support a large-scale Medicaid technology and operations initiative.
This position will serve as a subject matter expert (SME) supporting medical code change requests, policy analysis, business process improvements, and MMIS-related enhancements. The ideal candidate will have a combination of clinical knowledge, payer-side coding experience, and the ability to collaborate with technical and operational teams.
This is an excellent opportunity for professionals who enjoy complex, change-oriented projects and working cross-functionally with healthcare, policy, and IT stakeholders.
Key Responsibilities
- Support annual and quarterly ICD-10 and CPT/HCPCS coding updates from CMS
- Review coding changes and determine scope and business impact
- Prepare code change documentation for operational and program review
- Conduct meetings with stakeholders, business owners, and agency personnel
- Serve as a subject matter expert (SME) for:
- Medical coding methodologies
- Medicaid policy
- Healthcare claims and business processes
- Research business rules, requirements, and workflow models
- Develop analysis and recommendations for policy and process improvements
- Maintain documentation repositories for business rules and requirements
- Collaborate with cross-functional teams to support process documentation and training materials
- Participate in MMIS enhancement and modernization initiatives
- Provide backup support for medical necessity reviews when needed
Required Skills
- 5 years in healthcare insurance; medical review, program integrity, or appeals
- 5 years working with IT developers/programmers in a payor environment
- 5 years Medical Coding in payer environment
- 3 years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills)
- 5 years knowledge of ICD/CPT/HCPCS translation and coding methodologies
- 5 years knowledge of anatomy, physiology, pharmacology, and medical terminology
Preferred Skills
- 5 years’ experience in policy remediation
- 5 years claims processing systems experience
- 5 years Optum Encoder and/or other medical coding software programs
Required Education
- Bachelor of Science in Nursing (BSN)
- OR
- Associate Degree in Nursing (ADN)
Required Certifications
- Current, active, and unrestricted Registered Nurse (RN) license
- Current CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential
- ICD-10 proficiency demonstrated by exam or ability to become certified within one year of employment
Additional Qualifications
- Strong written and verbal communication skills
- Excellent collaboration and relationship-building abilities
- Experience managing multiple priorities simultaneously
- Strong time management and analytical skills
- Knowledge of Microsoft Office Suite