The Role
Supports Medicaid medical code maintenance by researching CMS coding updates, analyzing ICD-10 and CPT/HCPCS changes, and recommending business and process updates. Serves as a medical coding and Medicaid policy subject matter expert, maintains business rules and requirements, supports MMIS enhancements, and collaborates with stakeholders on documentation, training, claims research, and process improvements.
Summary Generated by Built In
The South Carolina Department of Health & Human Services (SCDHHS) is the State Medicaid
Agency for South Carolina. The Business Analyst will support the medical code change
requests by researching and making recommendations to policy and process owners and
stakeholders for review and approval. The position will also participate as a project team
member, as assigned, for related process improvements, Medicaid Management Information
System (MMIS) enhancements and provide subject matter expertise for a future MMIS
replacement. The position we are seeking to fill is for a candidate with a background in
healthcare and is a Certified Medical Coder.
Candidates who enjoy working on complex, change-oriented projects with motivated team
members will find this position attractive.
WHY IS THIS POSITION OPEN (new role, increased workload, new dept., resignation, promotion)?
The workload and complexities of the reference administration responsibilities require
additional support to maintain efficiency and to achieve defined deliverable dates. The
additional position will allow us to finalize succession planning for the Reference
Administration team.
WHAT TYPES OF STAFFING CHALLENGES OR HEADACHES HAVE YOU EXPERIENCED IN THE PAST?
• This position requires an individual with strong analytical skills and experience in:
➢ Managing multiple work efforts simultaneously
➢ Medical Coding
➢ Clinical background – not required but could be beneficial
➢ Time management skills
➢ CPT/HCPCS and ICD-10 translation knowledge and ability to
learn how medical codes link to claims processing
➢ Ability to understand business and functional requirements
• Please ensure that your candidates have strength in these areas. Candidates with
hospital, office, or clinic settings experience will be beneficial.
• The candidate must have strong collaboration and relationship building skills.
• Experience in healthcare or degree to align with healthcare environment
SCOPE OF THE PROJECT:
This project is a multi-year-old effort which primarily focuses on providing consulting services
to operations and policy staff for the current Medicaid Management Information System
(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. It is necessary to build and
sustain a strong staff who understands coding, aids staff in understanding CPT/HCPCS and
ICD-10 coding and apply the codes correctly within the Reference Administration sub-system.
POSITION:
IT Healthcare Consultant – Business Analyst -
Advanced
PRE-EMPLOYMENT CHECKS?
State mandatory - Criminal, Credit and E-Verify background checks
OBJECTIVES TO BE FULFILLED BY CANDIDATE:
The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code
maintenance. As the IT Healthcare Consultant – Business Analyst – Advanced (Clinical Analyst
and Coding Specialist):
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 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.
• Research 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.
• May serve as a back-up to other roles within the bureau to support claim escalations
research, once the person has demonstrated full proficiency in the job functions
required for their new role
• Other project-related duties, as assigned or required
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• 3+ years’ experience in healthcare
• Strong knowledge of ICD/CPT/HCPCS
translation and coding methodologies
• 3+ years extensive knowledge of
anatomy, physiology, pharmacology,
and medical terminology
PREFERRED SKILLS (RANK IN ORDER OF
IMPORTANCE):
• 3+ years’ experience healthcare
hospital, office and clinic setting
• Knowledge of Microsoft Office
(Word, Excel, PowerPoint, Optum
Encoder and other medical coding
• 3+ years of strong knowledge of
formal business process
documentation
software programs)
• Other: preference for resources that
are local to SC, NC, or GA. Resources
can reside anywhere in the US – but
must be willing to travel onsite to
Columbia, SC within notice from
management at the resources
expense.
REQUIRED EDUCATION:
Bachelor’s degree in healthcare related field.
An equivalent combination of experience and
education may be considered with prior
SCDHHS hiring team review and approval.
REQUIRED CERTIFICATIONS:
Currently credentialed as CPC (Certified
Professional Coder) or as CCS (Certified
Coding Specialist).
INTERVIEW PROCESS (who will conduct i/v,
phone or in-person, how many rounds of i/v)?
The interviews will be conducted by a team
either in-person or via video conferencing.
SCHEDULE INTERVIEW: How soon can you
schedule an interview (date / times)?
Once qualified resumes and candidates have
been received.
ADDITIONAL SKILLS / Notes:
• Written and oral communications skills, strong proficiency in English
• Ability to effectively communicate with executive management, line management,
project management, and team members
Requirements
COMPANY / DEPARTMENT CULTURE:
The South Carolina Department of Health & Human Services (SCDHHS) is the State Medicaid Agency for South Carolina. The Business Analyst will support the medical code change requests by researching and making recommendations to policy and process owners and stakeholders for review and approval. The position will also participate as a project team member, as assigned, for related process improvements, Medicaid Management Information System (MMIS) enhancements and provide subject matter expertise for a future MMIS replacement. The position we are seeking to fill is for a candidate with a background in healthcare and is a Certified Medical Coder.
Candidates who enjoy working on complex, change-oriented projects with motivated team members will find this position attractive.
WHY IS THIS POSITION OPEN (new role, increased workload, new dept., resignation, promotion)?
The workload and complexities of the reference administration responsibilities require additional support to maintain efficiency and to achieve defined deliverable dates. The additional position will allow us to finalize succession planning for the Reference Administration team.
WHAT TYPES OF STAFFING CHALLENGES OR HEADACHES HAVE YOU EXPERIENCED IN THE PAST?
• Recruiters submitting multiple, clearly unqualified candidates.
• This position requires an individual with strong analytical skills and experience in:
? Managing multiple work efforts simultaneously
? Medical Coding
? Clinical background – not required but could be beneficial
? Time management skills
? CPT/HCPCS and ICD-10 translation knowledge and ability to learn how medical codes link to claims processing
? Ability to understand business and functional requirements
• Please ensure that your candidates have strength in these areas. Candidates with hospital, office, or clinic settings experience will be beneficial.
• The candidate must have strong collaboration and relationship building skills.
• Experience in healthcare or degree to align with healthcare environment
SCOPE OF THE PROJECT:
This project is a multi-year-old effort which primarily focuses on providing consulting services to operations and policy staff for the current Medicaid Management Information System (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. It is necessary to build and sustain a strong staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and apply the codes correctly within the Reference Administration sub-system.
OBJECTIVES TO BE FULFILLED BY CANDIDATE:
The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. As the IT Healthcare Consultant – Business Analyst – Advanced (Clinical Analyst and Coding Specialist):
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 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.
• Research 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.
• May serve as a back-up to other roles within the bureau to support claim escalations research, once the person has demonstrated full proficiency in the job functions required for their new role
• Other project-related duties, as assigned or required
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• 3+ years’ experience in healthcare
• Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
• 3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
• 3+ years of strong knowledge of formal business process documentation
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• 3+ years’ experience healthcare hospital, office and clinic setting
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
REQUIRED EDUCATION:
Bachelor’s degree in healthcare related field. An equivalent combination of experience and education may be considered with prior SCDHHS hiring team review and approval. REQUIRED CERTIFICATIONS:
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
Skill Type
Skill Name
CertificationEducationLicenseOtherSkill
Bachelor’s degree in healthcare related field.
CertificationEducationLicenseOtherSkill
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
CertificationEducationLicenseOtherSkill
3+ years’ experience in healthcare
CertificationEducationLicenseOtherSkill
Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
CertificationEducationLicenseOtherSkill
3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
CertificationEducationLicenseOtherSkill
3+ years of strong knowledge of formal business process documentation
Skill Type
Skill Name
CertificationEducationLicenseOtherSkill
3+ years’ experience healthcare hospital, office and clinic setting
CertificationEducationLicenseOtherSkill
Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
CertificationEducationLicenseOtherSkill
Resource is local to South Carolina, North Carolina, or Georgia
Skills Required
- Bachelor's degree in a healthcare-related field, or an approved equivalent combination of education and experience
- Currently credentialed as a CPC (Certified Professional Coder) or CCS (Certified Coding Specialist)
- At least 3 years of healthcare experience
- Strong knowledge of ICD-10, CPT, and HCPCS translation and coding methodologies
- At least 3 years of extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
- At least 3 years of experience with formal business process documentation
- Experience in a healthcare hospital, office, or clinic setting
- Knowledge of Microsoft Office, Optum Encoder, and other medical coding software
- Willingness to travel onsite to Columbia, South Carolina when requested
- Local to South Carolina, North Carolina, or Georgia
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The Company
What We Do
Novalink Solutions LLC is a global consulting, engineering, and AI product development company specializing in information technology and telecommunications. They provide AI-powered products, automation platforms, intelligent workflow systems, IT consulting, managed engineering, and staff augmentation services.
