Business Analyst - Project Lead

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Job description

• Only qualified Business Analyst - Project Lead candidates located near the Columbia, SC area to be considered due to the position requiring an onsite presence

REQUIRED EDUCATION:

RN or LPN in South Carolina and Medical Coding Certification

REQUIRED CERTIFICATIONS:

Current nursing license in South Carolina

Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist)

ICD-10 Proficiency demonstrated by exam

REQUIRED SKILLS / EXPERIENCE:

Five 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

Strong knowledge of ICD/CPT/HCPCS translation

Strong knowledge of ICD/CPT/HCPCS coding methodologies

Extensive knowledge of anatomy, physiology, pharmacology, and medical terminology

Superb written and oral communications skills, strong proficiency in English is required

Strong knowledge of formal business process documentation

Ability to effectively communicate with executive management, line management, project management, and team members

PREFERRED SKILLS

Experience in policy remediation

Claims processing systems experience

Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and or other medical coding software programs)

This project is a multi-year effort which primarily focuses on providing consulting services to operations and policy staff for the current.

The current position's focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers. A long-term plan includes participating and providing guidance in the administrative approach for the replacement management system. It is necessary to build and sustain a strong Medical Coding staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and applies the codes correctly within the Reference Administration sub-system.

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) 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

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

Other project-related duties

• Only those lawfully authorized to work in the designated country associated with the position will be considered.

• Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements.

Benefits:

For information and details on employment benefits offered with this position, please visit here . Should you have any questions/concerns, please contact our HR Department via our secure website .

California Pay Equity:

For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here .

Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.

If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department .

Rose International has an official agreement (ID ), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).

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