Business Analyst
Posted 1 week ago by Refulgent Technologies Inc.
Negotiable
Undetermined
Remote
Remote
Summary: The Business Analyst role involves collaborating with internal teams to manage code changes and updates in a healthcare setting, specifically focusing on Medicaid programs. The position requires expertise in medical coding methodologies and participation in agency projects, ensuring compliance with coding standards and documentation. The analyst will serve as a subject matter expert and lead meetings with stakeholders to facilitate effective communication and project execution. This remote position is open to candidates residing in South Carolina only, with no relocation options available.
Key Responsibilities:
- Collaborates with internal recipients and owners to determine the scope of code changes for planning and timely completion.
- Receives and analyzes listings of code changes distributed to relevant staff.
- Acts as an approver in the code change/update process following CMS updates.
- Leads meetings with agency personnel, stakeholders, and process owners.
- Serves as a subject matter expert for medical coding methodologies and Medicaid policy.
- Researches business rules, requirements, and models for analysis and recommendations.
- Maintains business rules, requirements, and models in a repository.
- Collaborates with the team to ensure complete process documentation and training content.
- Participates in agency projects requiring subject matter expertise.
- Performs other duties as assigned or required.
Key Skills:
- 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 with strong clinical assessment and critical thinking skills.
- 5 years strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
Salary (Rate): undetermined
City: undetermined
Country: undetermined
Working Arrangements: remote
IR35 Status: undetermined
Seniority Level: undetermined
Industry: Other
Job: Business Analyst
Location: remote ( Must be SC Resident, No relocation)
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.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
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.