Excelraise, LLC is a leading provider of full-service IT solutions and a talent management company headquartered in Denver, CO. At Excelraise, we specialize in IT staffing solutions tailored for government and federal clients across the USA.

Excelraise, LLC values your referrals! Refer qualified candidates for our open Job Postings and earn a generous REFERRAL BONUS for successful placements. Submit referrals here: Excelraise Referral Program.

Excelraise, LLC is seeking a Business Analyst Consultant (Remote Job) for our client in Columbia, SC.

***This is Fully Remote Job***Candidate MUST be a SC resident. No relocation allowed***

This project is an immediate support need that will primarily focus on providing consulting services to operations and policy staff for the current medical coding federal requirements, quarterly and intermittently, and all coding changes associated with agency initiatives to ensure compliance policy and code change alignment. Note – Medicaid Management Information System (MMIS) is the system of record.

Responsibility:

• 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.

Required Skills

• Bachelor’s degree in Health Information, Healthcare Administration, or related field; equivalent experience may be considered with a minimum of 3+ years of direct supervisor experience.
• 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.

Preferred Skills

• 5+ years’ experience in policy remediation.
• 5+ years’ Medical Claim processing systems experience.
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs).