IT Healthcare Consultant Clinical Analyst & Coding Specialist for Hybrid

Job Title: IT Healthcare Consultant - Business Analyst - Advanced (Clinical Analyst and Coding Specialist) Duration of the Contract: 12 months Possibility for Extension: Yes Work Location: Hybrid (20% onsite - must be available to come onsite periodically) Description: The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. As the IT Healthcare Consultant – Business Analyst – Advanced (Clinical Analyst and Coding Specialist): Specific duties include, but are not limited to: • 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. REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE): • 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. ADDITIONAL SKILLS: • 5+ years written and oral communications skills, strong proficiency in English. PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE): • 5+ years’ experience in policy remediation. • 5+ years claims processing systems experience. • 5+ years knowledge of Microsoft Office • 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: • Must have current, active, and non-restricted licensure by the client 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; or able to become certified within one year of employment.

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