Clinical Data Analyst

Job Title: Clinical Data Analyst

Job Location: Candidate must be a current resident of South Carolina

Job Duration: 12+ Months Contract

Pay rate: $84/hrs. on W2 (All inclusive)

Job Responsibilities:

The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance.

Specific duties include, but are not limited to:

• 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.

Other duties, as assigned or required.

Required Skills (rank in order of Importance):

• 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 (rank in order of Importance):

• 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).