Healthcare Business Analyst (Remote MUST be a SC resident)

Summary: The Healthcare Business Analyst role requires a candidate with extensive experience in healthcare insurance, medical coding, and collaboration with IT developers in a payer environment. The position emphasizes strong clinical assessment skills and knowledge of coding methodologies. The role is remote but requires residency in South Carolina. Candidates must hold relevant nursing degrees and certifications.

Key Responsibilities:

• Conduct medical reviews and program integrity assessments.
• Collaborate with IT developers/programmers in a payer environment.
• Perform medical coding in a payer environment.
• Utilize clinical experience for strong assessment and critical thinking.
• Apply knowledge of ICD/CPT/HCPCS coding methodologies.
• Maintain knowledge of anatomy, physiology, pharmacology, and medical terminology.

Key Skills:

• 5+ years in healthcare insurance; medical review, program integrity, or appeals.
• 5+ years working with IT developers/programmers in a payor environment.
• 5+ years Medical Coding in payer environment.
• 3+ years clinical experience in a healthcare environment.
• 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
• 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.
• 5+ years' experience in policy remediation (preferred).
• 5+ years claims processing systems experience (preferred).
• 5+ years Optum Encoder and/or other medical coding software programs (preferred).
• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN).
• Current, active, and non-restricted licensure by the SC Board of Nursing as a Registered Nurse.
• CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credentialed.
• ICD-10 Proficiency demonstrated by exam or ability to become certified within one year of employment.

Salary (Rate): undetermined

City: undetermined

Country: United States

Working Arrangements: remote

IR35 Status: undetermined

Seniority Level: undetermined

Industry: Other