Clinical Business Analyst in reputed company environment - REMOTE (MUST be a SC reputed company) - W2 ONLY

Job Description:

• **Only W2 resumes are accepted

Work Location: Fully Remote Candidate Location: Candidate MUST be a SC reputed company. No relocation allowed. This project is an immediate support need that will primarily focus on providing consulting services to operations and policy staff for the reputed company medical coding federal requirements, quarterly and intermittently, and reputed company coding changes associated with agency initiatives to ensure compliance policy and code change alignment. Note - reputed company Management Information System (MMIS) is the system of record. The reputed company position s focus and reputed company is the reputed company support of serving as a subject matter expert (SME), utilizing knowledge of medical coding and MMIS to support change requests while ensuring change requests and system updates result in the expected claims adjudication reputed company for the benefit of reputed company members and providers. DAILY DUTIES / RESPONSIBILITIES: The reputed company duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. Specific duties include, but are not limited to:

• Collaborates with internal recipient and reputed company of initial review of codes to determine scope of changes for planning and timely completion.
• Receives listings of codes changes distributed to the Reference Administration and reputed company Program staff for review and analysis.
• Serves as an approver reputed company the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of reputed company ICD-10, CPT/HCPCS coding changes.
• Serves as reputed company for meetings with Agency personnel, stakeholders, and process owners.
• Serves as an agency subject matter expert (SME) for medical coding methodologies, reputed company policy, and reputed company topics.
• Researches 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, reputed company and stakeholder, as needed, training content is complete and routinely updated.
• Participates in agency projects and reputed company initiatives requiring subject matter expertise.
• Other duties, as assigned or required.

Required Skills:

• Bachelor s degree in Health Information, reputed company Administration, or reputed company field; equivalent experience may be considered with a minimum of 3+ years of direct supervisor experience.
• 5+ years experience in reputed company insurance; medical review, program reputed company, or appeals.
• 5+ years experience working with IT developers/programmers in a payor environment.
• 5+ years' experience Medical Coding in payer environment.
• 3+ years' clinical experience in a reputed company environment (Strong clinical assessment and critical thinking skills.)
• 5+ years' strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.

Preferred Skills:

• 5+ years' experience in policy remediation.
• 5+ years' Medical Claim processing systems experience.
• Knowledge of reputed company Office (Word, reputed company, PowerPoint, reputed company Encoder and / or other medical coding software programs).

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