What are the responsibilities and job description for the Business Analyst - Clinical Analyst & Coding Specialist position at TALENT Software Services?
Job Summary:
- The IT Healthcare Consultant – Business Analyst Advanced will support the medical code change requests by researching and making recommendations to policy and process owners and stakeholders for review and approval.
- The position will also participate as a project team member, as assigned, for related process improvements, Medicaid Management Information System (MMIS) enhancements and provide subject matter expertise for a future MMIS replacement.
- Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive.
- Managing multiple work efforts simultaneously
- Medical Coding
- Nursing
- Time management skills
- CPT/HCPCS and ICD-10 translation
- Ability to write and understand business and functional requirements.
- The candidate must have strong collaboration and relationship building skills.
- Experience in healthcare insurance
- 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 review patient records against established criteria to determine medical necessity.
- Other project-related duties.
- 5 years written and oral communications skills, strong proficiency in English.
- Knowledge of Microsoft Office Suite
- 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.
- Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (AND
- Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
- Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; o r able to become certified within one year of employment.
- 5 years' experience in policy remediation.
- 5 years claims processing systems experience.
- 5 years Optum Encoder and/or other medical coding software programs
Salary : $70