Business Analyst – Consultant (Reference Administration)
Job Title: Business Analyst – Consultant (Reference Administration) (10851) Location: Columbia, SC (Remote – Candidate must be SC resident) Duration: 12 Months (Extension Possible) Interview: 1 Round – Virtual
Key Responsibilities
- Support medical code change lifecycle including analysis, validation, and implementation
- Research and document business rules, requirements, and process workflows
- Collaborate with policy owners, stakeholders, and IT teams for approvals and updates
- Act as SME for ICD-10, CPT, and HCPCS coding methodologies
- Analyze and resolve complex MMIS-related issues
- Participate in MMIS enhancements and process improvement initiatives
- Facilitate stakeholder meetings and communicate across technical and non-technical teams
- Maintain documentation repository for business requirements and coding changes
- Ensure updates result in accurate claims adjudication outcomes
- Support training documentation and knowledge transfer activities
Required Skills & Experience
- Bachelor’s degree in Health Information, Healthcare Administration, or related field
- OR equivalent experience with 3+ years of supervisory experience
- 5+ years in healthcare insurance (medical review, program integrity, or appeals)
- 5+ years working with IT developers/programmers in a payer environment
- 5+ years of medical coding experience (payer side)
- 3+ years clinical experience in a healthcare setting
- Strong knowledge of ICD-10, CPT, HCPCS coding and translation methodologies
- Experience with business analysis, requirements gathering, and documentation
- Strong analytical, problem-solving, and communication skills
- Ability to manage multiple priorities and deadlines
Preferred Skills
- 5+ years experience in policy remediation
- Experience with medical claims processing systems
- Familiarity with tools such as:
- Microsoft Office (Excel, Word, PowerPoint)
- Optum Encoder or other coding tools
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