Business Analyst

Job: Business Analyst Location: remote ( Must be SC Resident, No relocation) Specific duties include, but are not limited to: Collaborates with internal recipient and owner 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 Medicaid Program staff for review and analysis. Serves as an approver within the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes. Serves as lead for meetings with Agency personnel, stakeholders, and process owners. Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related 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, owner and stakeholder, as needed, training content is complete and routinely updated. Participates in agency projects and related initiatives requiring subject matter expertise. Other duties, as assigned or required. REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE): 5 years experience in healthcare insurance; medical review, program integrity, 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 healthcare environment (Strong clinical assessment and critical thinking skills.) 5 years strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.