Medicaid (MMIS) CPT/HCPCS and ICD-10 translation Business Analyst

REQUIRED SKILLS

(RANK

IN ORDER OF IMPORTANCE

):

• 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 (strong clinical assessment and critical thinking skills.

) 5+ years knowledge of

ICD/CPT/HCPCS

translation and coding methodologies. 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.

PREFERRED SKILLS

(RANK

IN ORDER OF IMPORTANCE

): 5+ years experience in policy remediation. 5+ years claims processing systems experience. 5+ years Optum Encoder and/or other medical coding software programs The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. As the IT Healthcare Consultant - Business Analyst - Advanced (Clinical Analyst and Coding Specialist): Specific duties include, but are not limited to: Initiates annual (and quarterly) updates from CMS of all

ICD-10, CPT/HCPCS

coding changes. Performs initial review of codes to determine scope of changes. Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis. Conducts meetings with Agency personnel, stakeholders, and process owners. (Future) Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required. Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics. Research 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. May serve as a back-up to review patient records against established criteria to determine medical necessity. Other project-related duties. 5+ years written and oral communications skills, strong proficiency in English. Knowledge of Microsoft Office Suite