Business Analyst - Advanced - Clinical Analyst

About the role

This is a 12‑month contract position with possible extension, based at 1201 Main Street, Suite 600, Columbia, SC 29201. The role is 80 % remote, requiring occasional on‑site attendance in Columbia for trainings and meetings; candidates may reside anywhere in the U.S. but must be willing to travel on‑site at their own expense, with a strong preference for those local to SC, NC, or GA. The State of South Carolina seeks an IT Healthcare Consultant – Business Analyst – Advanced – Clinical Analyst to provide consulting services for the Medicaid Management Information System (MMIS), serve as a subject‑matter expert on medical coding, and support reference administration activities.

Responsibilities

• Initiate annual (and quarterly) updates from CMS of all ICD‑10, CPT/HCPCS coding changes.
• Perform initial review of codes to determine scope of changes.
• Prepare listings of code changes for Reference Administration staff and Medicaid Program staff for review and analysis.
• Conduct meetings with Agency personnel, stakeholders, and process owners.
• (Future) Participate in DASH (Replacement MMIS) project meetings as needed, where reference administration expertise is required.
• Serve as an agency subject‑matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
• Research business rules, requirements, and models to complete initial analysis and recommendations.
• Maintain business rules, requirements, and models in a repository.
• Collaborate with the team to ensure process documentation is complete, owner and stakeholder training content is complete and routinely updated.
• May serve as a back‑up to other roles within the bureau to support claim escalations research after demonstrating full proficiency in the job functions.

Requirements

Bachelor’s degree in a healthcare‑related field (or an equivalent combination of experience and education approved by the SCDHHS hiring team). Must hold a current Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credential.

Skills

Required skills (in order of importance):

• 3+ years’ experience in healthcare.
• Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
• 3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.
• 3+ years of strong knowledge of formal business process documentation.

Preferred skills (in order of importance):

• 3+ years’ experience in healthcare hospital, office, and clinic settings.
• Knowledge of Microsoft Office (Word, Excel, PowerPoint) and medical coding software such as Optum Encoder.

Additional competencies emphasized in the posting include strong analytical skills, ability to manage multiple work efforts simultaneously, time‑management skills, collaboration and relationship‑building abilities, and familiarity with healthcare environments (hospital, office, or clinic) is beneficial.