Looking for Clinical Analyst & Coding Specialist- W2 Only (SC Resident) - 100% Remote

Below are the job details for your reference:

Title:

Clinical Analyst & Coding Specialist- W2

Location:

100%

Remote Duration:

12+ Months from projected start date Hrs./Wk.: 40

Note:

Candidate MUST be a SC resident. No relocation allowed.

Scope:

This resource will assist with the CPT/HCPCS and ICD-10 code maintenance. An RN is required for the medical coding reviews. However, there is actual NO coding , but more review of coding data received, either by CMS or for internal initiatives, research is completed and what we, as an agency, should do, results in the recommendations that are then sent to areas of the agency for review, input and, ultimately, approval.

Required Skills:

Must have current, active, and non-restricted licensure by the South Carolina Board of Nursing as a Registered Nurse. 5+ years in healthcare insurance; medical review, program integrity, or appeals. Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN) 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:

5+ years experience in policy remediation. 5+ years claims processing systems experience. 5+ years Optum Encoder and/or other medical coding software programs