RN Clinical Coding Analyst
Job Title: IT Healthcare Consultant – Business Analyst - Advanced (Clinical Analyst & Coding Specialist)
Location: Columbia, SC (Fully Remote – Candidate must reside in South Carolina)
Duration: 12 Months (Possible Extension)
Interview Process: 1 Round – Virtual/Online
Key Responsibilities
• Initiate annual and quarterly ICD-10, CPT, and HCPCS coding updates from CMS
• Review and analyze coding changes to determine business and operational impacts
• Prepare code change listings for Reference Administration and Medicaid Program teams
• Conduct meetings with agency personnel, stakeholders, and process owners
• Serve as SME for medical coding methodologies and Medicaid policy
• Research business rules, requirements, and models to provide recommendations
• Maintain business rules and documentation repositories
• Collaborate with teams to ensure documentation and training materials are updated
• Participate in MMIS enhancement and future replacement initiatives
• Support medical necessity reviews when required
• Assist with process improvement initiatives and project-related activities
Required Skills
• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
• Active, unrestricted South Carolina Registered Nurse (RN) license
• CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification
• ICD-10 proficiency certification or ability to obtain within one year
• 5+ years healthcare insurance experience (medical review, appeals, or program integrity)
• 5+ years working with IT developers/programmers in a payer environment
• 5+ years medical coding experience in payer environment
• 3+ years clinical healthcare experience with strong assessment skills
• 5+ years knowledge of ICD/CPT/HCPCS coding methodologies
• Strong understanding of anatomy, physiology, pharmacology, and medical terminology
• Strong analytical, communication, collaboration, and relationship-building skills
• Experience managing multiple work efforts simultaneously
• Ability to write and understand business and functional requirements
Preferred Skills
• 5+ years policy remediation experience
• 5+ years claims processing systems experience
• Experience with Optum Encoder and other medical coding software programs
• Government operations and managed care background preferred
Additional Information
• Fully Remote role; however, candidate must currently reside in South Carolina
• No relocation permitted
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Location: Columbia, SC (Fully Remote – Candidate must reside in South Carolina)
Duration: 12 Months (Possible Extension)
Interview Process: 1 Round – Virtual/Online
Key Responsibilities
• Initiate annual and quarterly ICD-10, CPT, and HCPCS coding updates from CMS
• Review and analyze coding changes to determine business and operational impacts
• Prepare code change listings for Reference Administration and Medicaid Program teams
• Conduct meetings with agency personnel, stakeholders, and process owners
• Serve as SME for medical coding methodologies and Medicaid policy
• Research business rules, requirements, and models to provide recommendations
• Maintain business rules and documentation repositories
• Collaborate with teams to ensure documentation and training materials are updated
• Participate in MMIS enhancement and future replacement initiatives
• Support medical necessity reviews when required
• Assist with process improvement initiatives and project-related activities
Required Skills
• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
• Active, unrestricted South Carolina Registered Nurse (RN) license
• CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification
• ICD-10 proficiency certification or ability to obtain within one year
• 5+ years healthcare insurance experience (medical review, appeals, or program integrity)
• 5+ years working with IT developers/programmers in a payer environment
• 5+ years medical coding experience in payer environment
• 3+ years clinical healthcare experience with strong assessment skills
• 5+ years knowledge of ICD/CPT/HCPCS coding methodologies
• Strong understanding of anatomy, physiology, pharmacology, and medical terminology
• Strong analytical, communication, collaboration, and relationship-building skills
• Experience managing multiple work efforts simultaneously
• Ability to write and understand business and functional requirements
Preferred Skills
• 5+ years policy remediation experience
• 5+ years claims processing systems experience
• Experience with Optum Encoder and other medical coding software programs
• Government operations and managed care background preferred
Additional Information
• Fully Remote role; however, candidate must currently reside in South Carolina
• No relocation permitted
Apply tot his job
Apply To this Job