Business Analyst

5 days ago

Columbia, South Carolina, United States Rose International Full time
Job Title: Business Analyst - Project Lead

We are seeking a highly skilled Business Analyst - Project Lead to join our team at Rose International. As a Business Analyst - Project Lead, you will be responsible for leading projects related to medical coding and healthcare insurance.

Responsibilities:
  • Initiate annual and quarterly updates from CMS of all ICD-10, CPT/HCPCS coding changes
  • Perform initial review of codes to determine scope of changes
  • Prepare listings of code changes to Reference Administration staff and Medicaid Program staff for review and analysis
  • Conduct meetings with Agency personnel, stakeholders, and process owners
  • Participate in DASH (Replacement) project meetings, as needed, where reference administration expertise is required
  • Serve as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics
  • Research business rules, requirements, and models to complete initial analysis and recommendations
  • Maintain business rules, requirements, and models in a repository
  • Collaborate with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated
Requirements:
  • 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)

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.

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