Consulting role supporting operations and policy staff for a Medicaid Management Information System (MMIS). The position focuses on serving as a subject matter expert for medical coding, helping maintain CPT/HCPCS and ICD-10 code updates, supporting reference administration, and contributing to business analysis and process documentation efforts.
Key responsibilities include:
- Initiate annual and quarterly CMS code updates for ICD-10 and CPT/HCPCS changes
- Review code updates to determine scope and impact
- Prepare code change listings for Reference Administration and Medicaid Program staff
- Conduct meetings with agency personnel, stakeholders, and process owners
- Support future DASH/MMIS replacement project meetings as needed
- Serve as an SME for medical coding methodologies, Medicaid policy, and related topics
- Research business rules, requirements, and models to develop analysis and recommendations
- Maintain business rules, requirements, and models in a repository
- Collaborate on process documentation and training content updates
- Support claim escalation research as needed after full proficiency is demonstrated
Requirements & Qualifications
- 3+ years of experience in healthcare
- Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
- 3+ years of extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
- 3+ years of strong knowledge of formal business process documentation
- Experience in a healthcare hospital, office, or clinic setting preferred
- Familiarity with Microsoft Office, Optum Encoder, and other medical coding software preferred
- Bachelor's degree in a healthcare-related field, or equivalent combination of education and experience
- Current CPC or CCS credential required
Location
South Carolina, US
Employment Type
Contractor
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 month ago