RN Clinical Coding Analyst
Job Title: IT Healthcare Consultant – Business Analyst - Advanced (Clinical Analyst & Coding Specialist) Location: Columbia, SC (Fully Remote – Candidate must reside in South Carolina) Duration: 12 Months (Possible Extension) Interview Process: 1 Round – Virtual/Online
Key Responsibilities
- Initiate annual and quarterly ICD-10, CPT, and HCPCS coding updates from CMS
- Review and analyze coding changes to determine business and operational impacts
- Prepare code change listings for Reference Administration and Medicaid Program teams
- Conduct meetings with agency personnel, stakeholders, and process owners
- Serve as SME for medical coding methodologies and Medicaid policy
- Research business rules, requirements, and models to provide recommendations
- Maintain business rules and documentation repositories
- Collaborate with teams to ensure documentation and training materials are updated
- Participate in MMIS enhancement and future replacement initiatives
- Support medical necessity reviews when required
- Assist with process improvement initiatives and project-related activities
Required Skills
- Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
- Active, unrestricted South Carolina Registered Nurse (RN) license
- CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification
- ICD-10 proficiency certification or ability to obtain within one year
- 5+ years healthcare insurance experience (medical review, appeals, or program integrity)
- 5+ years working with IT developers/programmers in a payer environment
- 5+ years medical coding experience in payer environment
- 3+ years clinical healthcare experience with strong assessment skills
- 5+ years knowledge of ICD/CPT/HCPCS coding methodologies
- Strong understanding of anatomy, physiology, pharmacology, and medical terminology
- Strong analytical, communication, collaboration, and relationship-building skills
- Experience managing multiple work efforts simultaneously
- Ability to write and understand business and functional requirements
Preferred Skills
- 5+ years policy remediation experience
- 5+ years claims processing systems experience
- Experience with Optum Encoder and other medical coding software programs
- Government operations and managed care background preferred
Additional Information
- Fully Remote role; however, candidate must currently reside in South Carolina
- No relocation permitted
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