Senior Business Analyst
Senior Business Analyst
Posted on :
06-10-2024
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Job Description
Job Description: ***Please see the education and certification that is needed**
This is very specific and candidates submitted must have these requirements.
SCOPE OF THE PROJECT:
This project is a multiyear effort which primarily focuses on providing consulting services to operations and policy staff for the current MMIS.
The current positions 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 longterm 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 ICD10 coding and applies the codes correctly within the Reference Administration subsystem.
OBJECTIVES TO BE FULFILLED BY CANDIDATE:
The principal duties of this position are to assist with the CPT/HCPCS and ICD10 code maintenance.
Specific duties include but are not limited to:
Initiates annual (and quarterly) updates from CMS of all ICD10 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 MMIS) 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 projectrelated duties.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
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 (RANK IN ORDER OF IMPORTANCE):
Experience in policy remediation.
Claims processing systems experience.
Knowledge of Microsoft Office (Word Excel PowerPoint Optum Encoder and or other medical coding software programs).
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). ICD10 Proficiency demonstrated by exam.
Additional Sills: Experience working with IT developers/programmers in a payor environment (5 years required expert currently using); Strong knowledge of ICD/CPT/HCPCS translation (6years required expert currently using); Extensive knowledge of anatomy physiology pharmacology and medical terminology (6years required expert currently using); Strong knowledge of formal business process documentation (6years required expert currently using); experience in policy remediation (6years expert currently using); RN or LPN/Medical Coding Certification (6years required expert currently using); Current nursing license in South Carolina. Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD10 Proficiency demonstrated by exam (6years required expert currently using) Skills: Administrative Verbal Communication Skills Yes 1 Expert Currently Using 6 Years Administrative Written Communication Skills Yes 1 Expert Currently Using 6 Years Financial Claims Payment and Financial systems No 1 Expert Currently Using 6 Years Miscellaneous Ability to deal effectively with the needs of technical peers technical and user management users vendors and staff members and to communicate clearly and effectively in spoken and written form Yes 1 Expert Currently Using 6 Years Packaged Applications Microsoft Office Suite No 1 Expert Currently Using 6 Years Specialties Knowledge and experience in healthcare insurance payment methodologies. Yes 1 Expert Currently Using 4 6 Years Specialties Medical Coding Yes 1 Expert Currently Using 4 6 Years Specialties Strong knowledge of ICD/CPT/HCPCS coding methodologies Yes 1 Expert Currently Using 6 Years
This is very specific and candidates submitted must have these requirements.
SCOPE OF THE PROJECT:
This project is a multiyear effort which primarily focuses on providing consulting services to operations and policy staff for the current MMIS.
The current positions 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 longterm 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 ICD10 coding and applies the codes correctly within the Reference Administration subsystem.
OBJECTIVES TO BE FULFILLED BY CANDIDATE:
The principal duties of this position are to assist with the CPT/HCPCS and ICD10 code maintenance.
Specific duties include but are not limited to:
Initiates annual (and quarterly) updates from CMS of all ICD10 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 MMIS) 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 projectrelated duties.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
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 (RANK IN ORDER OF IMPORTANCE):
Experience in policy remediation.
Claims processing systems experience.
Knowledge of Microsoft Office (Word Excel PowerPoint Optum Encoder and or other medical coding software programs).
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). ICD10 Proficiency demonstrated by exam.
Additional Sills: Experience working with IT developers/programmers in a payor environment (5 years required expert currently using); Strong knowledge of ICD/CPT/HCPCS translation (6years required expert currently using); Extensive knowledge of anatomy physiology pharmacology and medical terminology (6years required expert currently using); Strong knowledge of formal business process documentation (6years required expert currently using); experience in policy remediation (6years expert currently using); RN or LPN/Medical Coding Certification (6years required expert currently using); Current nursing license in South Carolina. Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD10 Proficiency demonstrated by exam (6years required expert currently using)
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