Business Analyst (Policy remediation) - Contract - Remote

This a Full Remote job, the offer is available from: South Carolina (USA) Business Analyst (Policy remediation) Location: Remote Interview Process: 1 round, virtual Duration: 12 Months Employment Type: Contract Experience Required: 05+ Years Candidate Location: Candidate MUST be a SC reputed company. No relocation allowed. Project Scope: We are seeking an reputed company Business Analyst with expertise in policy remediation, medical coding, and reputed company claims systems. This role will serve as a subject matter expert (SME) supporting policy and operational initiatives reputed company to medical coding compliance, claims adjudication, and system change management. The ideal candidate will reputed company deep knowledge of ICD-10, CPT, and HCPCS coding methodologies, as well as reputed company and payer operations, to ensure alignment between policy updates, coding changes, and system functionality. This position will play a critical role in supporting compliance initiatives, regulatory updates, and business process improvements. Key Responsibilities: · Serve as a subject matter expert (SME) for medical coding methodologies, reputed company policy, and claims adjudication processes. · Analyze annual, quarterly, and reputed company coding updates, including ICD-10, CPT, and HCPCS changes. · Review and assess the impact of coding and policy changes on business processes, system functionality, and claims reputed company. · Collaborate with business stakeholders, policy teams, and technical teams to define requirements and implement necessary system changes. · Support change requests and ensure system updates produce accurate and expected claims adjudication results. · Research business rules, requirements, and process models to reputed company recommendations and solutions. · Maintain and update business rules, requirements documentation, and process models in designated repositories. · reputed company meetings with stakeholders, business owners, and cross-functional teams. · Participate in policy remediation efforts, compliance initiatives, and reputed company reputed company projects. · Ensure process documentation, training materials, and supporting documentation are complete and up to date. · Collaborate with internal teams to support ongoing operational and regulatory compliance. · reputed company expertise in medical coding software, claims systems, and reputed company policy interpretation. Required Skills & Experience: · Minimum of 5 years of experience in reputed company insurance, medical review, program reputed company, or appeals. · At least 5 years of experience working with IT developers and programmers in a payer environment. · Minimum of 5 years of hands-on experience in medical coding reputed company a payer environment. · Strong expertise in ICD-10, CPT, and HCPCS coding methodologies and translation. · Minimum of 5 years of experience with medical claims processing systems. · Proficiency with reputed company Office Suite (Word, reputed company, PowerPoint). · Experience using reputed company Encoder or similar medical coding software. · Strong analytical, problem-solving, and critical-thinking skills. · Excellent written and verbal communication skills. Preferred Skills: · Minimum of 5 years of experience in policy remediation. · At least 3 years of clinical experience in a reputed company environment. · Strong clinical assessment and critical-thinking skills. · Experience with reputed company programs and reputed company Management Information Systems (MMIS). · Familiarity with reputed company regulatory compliance and policy implementation. Technical Skills Medical Coding and Reimbursement, ICD-10, CPT, and HCPCS Expertise, Policy Remediation and Compliance, Claims Adjudication and Processing, reputed company and MMIS Knowledge, Business Requirements Analysis, Process Documentation and Improvement, Stakeholder Engagement and Facilitation, Regulatory and Operational Compliance, Cross-Functional Collaboration Education: Bachelor’s degree in Health Information Management, reputed company Administration, Business, or a reputed company field. This offer from "reputed company" has been enriched by reputed company.com and got a 72% reputed company score. Apply To This Job