Administration Business Analyst//12+Months Contract//Fully Remote//Only SC residents.
Posted Today by Golden Resources. Inc.
Negotiable
Undetermined
Remote
Remote or Hybrid in Columbia, South Carolina
Summary: The Administration Business Analyst role involves supporting CPT/HCPCS and ICD-10 code maintenance within a healthcare insurance context. The position requires collaboration with various stakeholders to ensure timely updates and compliance with coding changes. Candidates should possess strong analytical skills and a background in medical coding, Medicaid policy, and claims processing. This is a long-term contract position based in Columbia, South Carolina, with remote work options available.
Key Responsibilities:
- Assist with CPT/HCPCS and ICD-10 code maintenance.
- Collaborate with internal teams to determine scope of code changes.
- Review and analyze code changes distributed to relevant staff.
- Approve code changes following CMS updates.
- Lead meetings with agency personnel and stakeholders.
- Act as a subject matter expert for medical coding methodologies and Medicaid policy.
- Research business rules and requirements for analysis and recommendations.
- Maintain business rules and models in a repository.
- Ensure process documentation and training content are complete and updated.
- Participate in agency projects requiring subject matter expertise.
- Other duties as assigned.
Key Skills:
- Bachelor's degree in Health Information, Healthcare Administration, or related field; equivalent experience may be considered with a minimum of 3+ years of direct supervisor experience.
- 5+ years experience in healthcare insurance; medical review, program integrity, or appeals.
- 5+ years experience working with IT developers/programmers in a payor environment.
- 5+ years' experience in Medical Coding in a payer environment.
- 3+ years' clinical experience in a healthcare environment.
- 5+ years' strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
- 5+ years' experience in policy remediation.
- 5+ years' Medical Claim processing systems experience.
- Knowledge of Microsoft Office and medical coding software programs.
- Strong analytical, time management, and collaboration skills.
Salary (Rate): undetermined
City: Columbia
Country: United States
Working Arrangements: remote
IR35 Status: undetermined
Seniority Level: undetermined
Industry: IT
Our client is looking for a Administration Business Analyst to join their team!
Top skills you need to have:
Required Skills
- Bachelor s degree in Health Information, Healthcare Administration, or related field; equivalent experience may be considered with a minimum of 3+ years of direct supervisor experience.
- 5+ years experience in healthcare insurance; medical review, program integrity, or appeals.
- 5+ years experience working with IT developers/programmers in a payor environment.
- 5+ years' experience Medical Coding in payer environment.
- 3+ years' clinical experience in a healthcare environment (Strong clinical assessment and critical thinking skills.)
- 5+ years' strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
About Golden Technology
Golden Technology was founded in 1997 with the goal of developing people and driving innovation. In other words, our aim is to pair world-class technologists like you with amazing companies that are doing impactful work.
After an initially slow start, and way too many late nights playing Final Fantasy 7, Golden Technology built a unique recruiting engine that would quickly prove itself to deliver top-tiered talent to fortune 500 clients across the US, time and time again.
Golden Technology has built a culture around family and helping the people we touch succeed in both their work and personal lives. Oh, everyone says that? Try us, you ll see it.
We re helping people find their calling and their dream jobs; and through our Golden Community initiatives we are actively working to improve the communities in which we work, live, and play.
Title: Administration Business Analyst
Location: Columbia, South Carolina - Remote
Duration: long term Contract
Objectives to Be Fulfilled by Candidate:
The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance.
Specific duties include, but are not limited to:
- Collaborates with internal recipient and owner of initial review of codes to determine scope of changes for planning and timely completion.
- Receives listings of codes changes distributed to the Reference Administration and Medicaid Program staff for review and analysis.
- Serves as an approver within the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
- Serves as lead for meetings with Agency personnel, stakeholders, and process owners.
- Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
- Researches 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.
- Participates in agency projects and related initiatives requiring subject matter expertise.
- Other duties, as assigned or required.
- This position requires an individual with strong analytical skills and experience in:
- Managing multiple work efforts simultaneously
- Medical Coding
- Time management skills
- CPT/HCPCS and ICD-10 translation
- Ability to write and understand business and functional requirements.
- Medicaid Policy, coding changes, system functionality and success implementation of changes for the expected outcome
- Please ensure that your candidates have strengths in these areas. Please do not submit general Medical Coders with no structured background in business rules or claims processing, preferably Government Operations and Managed Care background.
- The candidate must have strong collaboration and relationship building skills.
- Experience in healthcare insurance.
Preferred Skills
- 5+ years' experience in policy remediation.
- 5+ years' Medical Claim processing systems experience.
- Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs).