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Executive Order 11246, Section 503 & VEVRAA EOE, including disability/vets
Healthcare Experience Medical Coding ICDCPTHCPCS Coding Methodologies Specialist
 
Requirement id 150851
Job title Specialist
Job location in Columbia, SC
Skills required Verbal Communication, Written Communication Skills, Business Data Models, Healthcare Experience Medical Coding ICD
Open Date 10-Dec-2024
Close Date
Job type Contract
Duration 12 Months
Compensation DOE
Status requirement ---
Job interview type ---
Apply
   Email Recruiter: coolsoft
Job Description Specialist: Verbal Communication, Written Communication Skills, Business Data Models, Healthcare Experience Medical Coding ICD

Job Title: Reference Administration Business Analyst And Coding Specialist - Lead-11453-1

No of Submissions : 2

Start date : 01/14/2025

Submission deadline : 12/17/2024

Client Info : Department of Health and Human Services

Note:

Q) INTERVIEW PROCESS (who will conduct i/v, phone or in-person, how many rounds of i/v)?

A) The interviews will be conducted by a team either in-person or via video conferencing.

Q) SCHEDULE INTERVIEW: How soon can you schedule an interview (date / times)?

A) Once qualified resumes and candidates have been received.


Description :

***Please read this request in detail - the following are needed - please do not submit candidates that do not have everything listed.**

Current nursing license in South Carolina and/or multi-State license AND Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.

SCOPE OF THE PROJECT:
This project is a multi-year effort which primarily focuses on providing consulting services to operations and policy staff for the current MMIS.

The current positions focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers. A long-term plan includes participating and providing guidance in the administrative approach for the replacement management system. It is necessary to build and sustain a strong Medical Coding staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and applies the codes correctly within the Reference Administration sub-system.

OBJECTIVES TO BE FULFILLED BY CANDIDATE:
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:
• 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.
• 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.
• Other project-related duties.

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 knowledge of ICD/CPT/HCPCS translation.

• Strong knowledge of ICD/CPT/HCPCS coding methodologies.

• Extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.

• Superb written and oral communications skills, strong proficiency in English is required.

• Strong knowledge of formal business process documentation.

• Ability to effectively communicate with executive management, line manage
 
Call 502-379-4456 Ext 100 for more details. Please provide Requirement id: 150851 while calling.
 
Other jobs in SC: Beaufort (1), Blythewod (2), Blythewood (3), Charleston (17), Columbia (37), Greenville (4), Hartsville (2), North Charleston (2), Overland Park (1), San Francisco (1), SENECA (4), South Carolina (1), Spartanburg (3), Unknown (2),
Verbal Communication job openings in Columbia, SC
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Note:

Q) INTERVIEW PROCESS (phone, video, or in-person, how many rounds of i/vs, etc.)?

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Note:

Q) INTERVIEW PROCESS (phone, video or in-person, how many rounds of i/vs, etc.)

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Note:

Q) INTERVIEW PROCESS (WHO WILL CONDUCT I/V, PHONE OR IN-PERSON, HOW MANY ROUNDS OF I/VS)?1 ROUND

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* INTERVIEW PROCESS (who will conduct i/v, phone or in-person, how many rounds of i/vs)?
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(Specialist: Verbal Communication, Written Communication Skills, Business Data Models, Healthcare Experience Medical Coding ICD in Columbia, SC)
     
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