What are the responsibilities and job description for the Clinical Analyst & Coding Specialist - Contract - Columbia, SC position at SUNSHINE ENTERPRISE USA LLC?
Clinical
Analyst & Coding Specialist
Location: Columbia,
SC Hybrid (80% remote, onsite for required trainings and meetings).
Interview Process: 1 round, Virtual/Online
Duration: 12 Months
Employment Type: Contract
Experience Required: 10 Years
Project Scope:
Seeking an experienced Business Analyst
(Clinical Analyst & Coding Specialist) to support ongoing Medicaid
operations and healthcare system initiatives. The consultant will serve as a
Subject Matter Expert (SME) for medical coding, Medicaid policy, and business
analysis while collaborating with business and technical teams to support
coding updates, policy implementation, and business process improvements.
Key Responsibilities:
· Coordinate annual
and quarterly ICD-10, CPT, and HCPCS code updates.
· Review and
analyze coding changes to determine business and operational impacts.
· Prepare code
change documentation for stakeholder review.
· Collaborate with
business users, stakeholders, and technical teams to implement coding and
policy updates.
· Participate in
meetings related to healthcare systems modernization initiatives.
· Serve as a
Subject Matter Expert (SME) for medical coding methodologies and
Medicaid-related processes.
· Research business
rules, requirements, and workflows to develop recommendations.
· Maintain business
rules, process documentation, and requirements repositories.
· Support process
documentation, knowledge transfer, and training activities.
· Review medical
records against established criteria to determine medical necessity when
required.
· Assist with
additional healthcare and project-related initiatives.
Required Skills & Experience:
· 10 years of
experience in healthcare insurance, medical review, program integrity, or
appeals.
· 5 years working
with IT developers/programmers in a payer environment.
· 5 years of
medical coding experience in a payer environment.
· 3 years of
clinical experience in a healthcare environment.
· Strong knowledge
of ICD-10, CPT, and HCPCS coding methodologies.
· Strong knowledge
of anatomy, physiology, pharmacology, and medical terminology.
· Experience
gathering business requirements and documenting business processes.
· Excellent
analytical, communication, and stakeholder management skills.
Preferred Skills:
· Experience with
healthcare policy remediation.
· Claims processing
systems experience.
· Microsoft Office
Suite proficiency.
· Experience with
Optum Encoder or other medical coding software.
· Medicaid and
healthcare payer systems experience.
· Experience
supporting healthcare system modernization initiatives.
Education
Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN).
Certification:
· Active,
unrestricted Registered Nurse (RN) license.
· Current CPC
(Certified Professional Coder) or CCS (Certified Coding Specialist)
certification.
· ICD-10
proficiency certification or ability to obtain certification within one year.