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Job: IT - SCDHHS - IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst
location:1201 Main Street Suite 600, Columbia South Carolina 29201
Job ID:13856
Client: State of SC
Type: W2
The State of South Carolina is looking for an IT Healthcare Consultant - Business Analyst - Advanced - Clinical Analyst
Why is this position open: New position - The position we are seeking to fill is for a candidate with a background in healthcare and is a Certified Medical Coder.
Will close to submissions on 10/07 at 5:00 PM EST.
Interview Process: 1 round, Virtual/Online
Duration of the Contract: 12 months
Possibility for Extension: Yes
Work Location: 80% remote, resources will need to come onsite in Columbia, SC to certain trainings/meetings
Candidate Location: Resource can reside anywhere in the US - must be willing to travel onsite to Columbia, SC within notice from management at the resources expense. Strong preference for resources that are local to SC, NC, or GA.
Full job description attached & required/preferred skills are stated below.
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).
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)
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).
The interviews will be conducted by a team either in-person or via video conferencing.
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