IT Healthcare Business Analyst – Clinical Coding & Medicaid SME

IT Healthcare Business Analyst – Clinical Coding & Medicaid SME

Location: Columbia, South Carolina, (Hybrid)

Employment Type: Long-Term Contract

CornerStone Technology Talent Services is seeking an experienced IT Healthcare Business Analyst who combines clinical nursing expertise, professional medical coding experience, Medicaid or payer knowledge, and strong business analysis skills.

This position will serve as a clinical and coding subject matter expert for enterprise healthcare technology initiatives. The analyst will evaluate regulatory and coding changes, translate healthcare requirements into system solutions, and collaborate with policy teams, business leaders, software developers, architects, and QA professionals.

Key Responsibilities

• Serve as the clinical and medical coding SME for healthcare technology initiatives
• Analyze ICD-10, CPT, and HCPCS updates and identify operational and system impacts
• Translate Medicaid policies, coding guidelines, and regulatory requirements into business and technical requirements
• Gather, document, analyze, and validate requirements for healthcare system enhancements
• Develop business rules, workflows, functional specifications, and process documentation
• Review medical necessity, reimbursement logic, coding methodologies, and claims-processing scenarios
• Support enterprise healthcare platforms, claims systems, and modernization or system-replacement initiatives
• Provide clinical guidance during development, testing, validation, and implementation
• Facilitate meetings between clinical, policy, operational, and technical stakeholders
• Partner with developers, architects, QA teams, business analysts, and healthcare leadership
• Recommend process improvements that increase coding accuracy, compliance, and operational efficiency
• Maintain project documentation, knowledge repositories, and supporting materials

Required Qualifications

• 10 years of experience supporting healthcare insurance, medical review, appeals, utilization management, or program integrity
• 5 years of experience working directly with IT development teams in a payer or managed-care environment
• 5 years of professional medical coding experience
• Clinical nursing experience with strong assessment and critical-thinking skills
• Experience translating healthcare regulations and policies into business and technical requirements
• Strong knowledge of ICD-10, CPT, HCPCS, medical coding methodologies, claims adjudication, and healthcare reimbursement
• Experience with requirements gathering, business process analysis, workflow documentation, and functional specifications
• Experience supporting enterprise healthcare applications or Medicaid technology initiatives
• Ability to communicate effectively with clinical, operational, policy, and technical stakeholders
• Strong knowledge of anatomy, physiology, pharmacology, medical terminology, clinical workflows, healthcare documentation, regulatory compliance, and medical necessity review

Required Credentials

• Associate Degree in Nursing or Bachelor of Science in Nursing
• Active Registered Nurse license
• Current CPC or CCS certification, or ability to obtain the required certification if applicable

Preferred Qualifications

• Medicaid program or MMIS experience
• Healthcare modernization or enterprise transformation experience
• Claims-processing platform experience
• Policy remediation and business process improvement experience
• Healthcare systems implementation experience
• Optum Encoder or similar medical coding software
• Microsoft Office Suite
• Healthcare technology consulting experience

Ideal Candidate

The ideal candidate has successfully bridged clinical operations, medical coding, healthcare policy, and enterprise technology. This person can evaluate complex healthcare requirements, communicate with both clinical and technical teams, and help deliver compliant, accurate, and effective Medicaid technology solutions.