IT Healthcare Consultant - Columbia, South Carolina, , United States
17 hours ago
Job description
The IT Healthcare Consultant<\/b> – Advanced Business Analyst (Clinical Coding Specialist) supports the South Carolina Department of Health & Human Services (SCDHHS) in maintaining and enhancing Medicaid Management Information System (MMIS) operations.
The consultant leads analysis and implementation of CMS -driven coding updates, translates regulatory requirements into actionable business rules, and collaborates closely with IT development teams and policy stakeholders.
This is a consultative, systems -focused role that supports ongoing modernization initiatives, regulatory compliance, and operational continuity within a complex Medicaid payer environment.
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Responsibilities<\/b>
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- Initiate and manage annual and quarterly CMS updates for ICD -10, CPT, and HCPCS codes.
- Perform impact analysis of coding changes and determine operational and system implications.
- Translate regulatory and coding updates into business rules, functional requirements, and system specifications.
- Prepare and distribute code change documentation to reference administration and Medicaid program staff.
- Conduct stakeholder meetings with agency personnel, process owners, and cross -functional teams.
- Serve as subject matter expert for medical coding methodologies, Medicaid policy, and related regulatory guidance.
- Maintain business rules, requirements, and reference documentation repositories.
- Collaborate with IT developers and programmers to support MMIS enhancements and future MMIS replacement initiatives.
- Contribute to process improvement efforts across claims and reference administration functions.
- Provide backup support for medical necessity reviews as needed.
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Requirements<\/h3>
Minimum Qualifications<\/b>
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- Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN).
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- Current, active, and unrestricted Registered Nurse (RN) license in South Carolina.
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- Current CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential.
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- Demonstrated ICD -10 proficiency or ability to obtain certification within one year of employment.
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- 5 years of experience in a healthcare insurance payer environment (medical review, program integrity, or appeals).
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- 5 years of medical coding experience within a payer environment.
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- 5 years of collaboration with IT developers or programmers in a payer -based system environment.
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- 5 years of experience with ICD -10, CPT, and HCPCS coding methodologies.
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- 3 years of clinical experience in a healthcare setting with strong assessment and critical thinking skills.
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- Strong knowledge of anatomy, physiology, pharmacology, and medical terminology.
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- Experience translating business rules into system or technical requirements.
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- Strong written and verbal communication skills in English.
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Preferred Qualifications<\/b>
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- Experience in policy remediation initiatives.
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- Experience with claims processing systems.
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- Experience with MMIS platforms and MMIS replacement initiatives.
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- Familiarity with Optum Encoder or similar medical coding software.
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- Experience supporting enterprise system modernization efforts.
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- Advanced proficiency in Microsoft Office applications.
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Additional Requirements<\/b>
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- Must be a current resident of South Carolina; relocation is not permitted.
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- Subject to State mandatory Criminal, Credit, and E -Verify background checks.
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- Participation in a one -round virtual interview process.
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Work Location and Schedule<\/b>
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Location:
Columbia, South Carolina
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Schedule:
Standard business hours (specific schedule to be determined by the agency)
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Work Arrangement:
Hybrid - approximately 20% onsite
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Benefits<\/h3>
Health Care:
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Health Care:
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Air InfoSec offers an Individual Coverage Health Reimbursement Arrangement (ICHRA), providing up to $350/month in tax -free reimbursements to help cover the cost of your own health insurance premium.
This gives you the flexibility to choose the plan that works best for you and your family.<\/div>
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Paid Time Off (PTO):<\/b>
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1 hour of PTO earned for every 20 hours worked.
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Can carryover up to 5 days of PTO to the next calendar year.
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Holidays:
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5 paid state holidays (annually)
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2 paid floating holidays (annually)
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Continuing Education:
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$100 per year to apply towards annual certification fees or educational training.
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