Senior Healthcare Business Analyst - Medical Coding (CPC/CCS)Position Overview This role combines healthcare business analysis, medical coding expertise, and process documentation to support CPT/HCPCS and ICD-10 code maintenance and related healthcare process improvements. The position serves as a subject matter expert in medical coding methodologies and supports research, analysis, recommendations, stakeholder collaboration, and ongoing business process documentation.
The role is well suited for a healthcare professional with strong medical coding knowledge who enjoys working on complex, change-oriented projects and collaborating with policy owners, stakeholders, and project teams.
What You'll Do - Initiate annual and quarterly updates from CMS covering ICD-10 and CPT/HCPCS coding changes.
- Perform initial reviews of codes to determine the 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.
- Participate in project meetings, as needed, where reference administration expertise is required.
- Serve as a subject matter expert 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.
- Support the completion and routine updating of training content for owners and stakeholders, as needed.
- May serve as a backup to other roles within the bureau to support claim escalation research after demonstrating full proficiency in the required job functions.
- Perform other project-related duties as assigned or required.
Required Qualifications - Bachelor's degree in a healthcare-related field.
- Currently credentialed as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist).
- 3+ years of experience in healthcare.
- Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
- 3+ years of extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.
- 3+ years of strong knowledge of formal business process documentation.
- Strong analytical skills.
- Ability to manage multiple work efforts simultaneously.
- Ability to understand business and functional requirements.
- Strong collaboration and relationship-building skills.
- Ability to understand CPT/HCPCS and ICD-10 translation and how medical codes link to claims processing.
An equivalent combination of experience and education may be considered with prior hiring team review and approval.
Preferred Qualifications - 3+ years of healthcare experience in hospital, office, and clinic settings.
- Knowledge of Microsoft Office, including Word, Excel, and PowerPoint.
- Knowledge of Optum Encoder and other medical coding software programs.
- Clinical background.
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