Reference Administration Business Analyst and Coding Specialist

5 days ago

Columbia, United States DP Professionals Full time
DPP is seeking a Reference Administration Business Analyst and Coding Specialist for an opportunity in Columbia, SC.

 

Work arrangement:

Partial Onsite: Up to 20% onsite required for in-person meetings

W2 position; 12+ months 

Required certifications:

Current nursing license in South Carolina and/or multi-State license AND currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).

ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment. 

Required education:

RN or LPN/Medical Coding Certification 

Project summary:

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

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 understand coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and applies the codes correctly within the Reference Administration sub-system.

The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. 

Responsibilities:

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 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 project-related duties. 

Required knowledge, skills, and abilities:

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 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 KSAs:

Experience in policy remediation.

Claims processing systems experience.

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

Public sector/government experience is strongly desired. 

Interested? Learn more:

Click the apply button or contact our recruiter Maricel at (url removed) to learn more about this position (#(phone number removed).

DPP offers a range of compensation and benefits packages to our employees and their eligible dependents. Call today to learn more about working with DPP.

Authorized US Worker - US Citizens and those authorized to work in the US are encouraged to apply. We are unable to sponsor at this time. EOE/AA/V/D

 

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