Business analyst (IT healthcare)-advanced.

Job Location: Columbia, SC (Hybrid) | Position Type: W2 Contract

About the role

The Business Analyst will support medical code change requests by researching and making recommendations to policy and process owners and stakeholders for review and approval. The position will also participate as a project team member, as assigned, for related process improvements, MMIS enhancements, and provide subject matter expertise for a future MMIS replacement. This multi‑year effort focuses on providing consulting services to operations and policy staff for the current MMIS, with a priority on serving as a subject matter expert (SME) to help policy and process owners make the best recommendations for Medicaid members and providers.

Responsibilities

• 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 code 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 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
• Research 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
• May serve as a back‑up to other roles within the bureau to support claim escalations research, once the person has demonstrated full proficiency in the job functions required for their new role
• Other project‑related duties, as assigned or required

Requirements

• 9‑10 years of overall experience with minimum 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

Qualifications

• Currently credentialed as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist)
• Bachelor's degree in a healthcare‑related field; an equivalent combination of experience and education may be considered with prior hiring team review and approval

Skills

• Healthcare, ICD‑10, CPT/HCPCS Coding, Medical Coding Methodologies
• Anatomy, Physiology, Pharmacology, Medical Terminology
• Business Process Documentation, Claims Processing, Business Rules Analysis, Requirements Gathering, Process Documentation
• Subject Matter Expertise, Stakeholder Collaboration
• Microsoft Office (Word, Excel, PowerPoint), Optum Encoder, Medical Coding Software
• 3+ years' experience in healthcare hospital, office, and clinic settings (preferred)
• Preference for resources local to SC, NC, or GA; resources can reside anywhere in the US but must be willing to travel onsite to Columbia, SC within notice from management at the resource's expense