What are the responsibilities and job description for the Business Analyst position at Ventures Unlimited Inc?
Job Title: IT Healthcare Consultant – Business Analyst – Advanced (Clinical Analyst & Coding Specialist)
Location: Fully Remote (South Carolina Residents Only)
Duration: 12 Months (Possible Extension)
Interview Process: 1 Round Virtual Interview
Position Overview:
Please note:
This role is focused on medical coding review, analysis, and healthcare business processes — not traditional hands-on coding production work.
Key Responsibilities:
- Initiate and manage annual and quarterly CMS ICD-10 and CPT/HCPCS code updates
- Review coding changes and analyze impacts to Medicaid programs and business operations
- Prepare code change documentation and recommendations for stakeholders and agency leadership
- Serve as a Subject Matter Expert (SME) for:
- Medical coding methodologies
- Medicaid policy
- Healthcare business rules
- Claims processing and reference administration
- Conduct meetings with agency personnel, stakeholders, and process owners
- Research business requirements, models, and policy impacts to support recommendations
- Maintain business rules, process documentation, and repository updates
- Collaborate with teams to ensure training materials and process documentation remain current
- Support medical necessity reviews and healthcare claims analysis as needed
Required Qualifications:
- 5 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 setting
Strong knowledge of:
- ICD-10
- CPT/HCPCS coding methodologies
- Medical terminology
- Anatomy, physiology, and pharmacology
- Strong analytical, communication, documentation, and collaboration skills
- Experience managing multiple priorities simultaneously
- Experience writing and understanding business and functional requirements
- Knowledge of Microsoft Office Suite
Preferred Qualifications:
- Experience with healthcare policy remediation
- Claims processing systems experience
- Experience with Optum Encoder or similar coding software
- Government healthcare or Managed Care experience preferred
Required Education & Certifications:
- Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
- Active, unrestricted Registered Nurse (RN) license in South Carolina
- CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification required
- ICD-10 proficiency certification preferred or ability to obtain within one year