Project OverviewThis is a long-running, multi-year effort that provides consulting services to operations and policy staff for the current MMIS. The focus of this role is to serve as a subject matter expert (SME), building knowledge that helps policy and process owners make the best recommendations for Medicaid members and providers. You will help staff understand CPT/HCPCS and ICD-10 coding and apply codes correctly within the Reference Administration sub-system.
Key Responsibilities- Initiate annual and quarterly updates from CMS for all ICD-10 and CPT/HCPCS coding changes.
- Perform initial code reviews to determine the scope of changes.
- Prepare listings of code changes for Reference Administration and Medicaid Program staff to review and analyze.
- Conduct meetings with agency personnel, stakeholders, and process owners.
- Participate in replacement MMIS project meetings where reference administration expertise is needed.
- Serve as an 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 keep process documentation and stakeholder training content complete and up to date.
- Once fully proficient, serve as back-up for other roles in the bureau, including claim escalation research.
- Perform other project-related duties as assigned.
Required Skills- 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 and the ability to manage multiple work efforts at the same time.
- Ability to learn how medical codes link to claims processing.
- Ability to understand business and functional requirements.
- Strong time management, collaboration, and relationship-building skills.
- Excellent written and oral communication skills, with strong proficiency in English.
- Ability to communicate effectively with executive management, line management, project management, and team members.
Preferred Skills- 3+ years of healthcare experience in hospital, office, or clinic settings.
- Proficiency with Microsoft Office (Word, Excel, PowerPoint), Optum Encoder, and other medical coding software.
- A clinical background is helpful but not required.
- Residence in SC, NC, or GA.
Education- Bachelor's degree in a healthcare-related field.
- An equivalent combination of education and experience may be considered, subject to the Client's hiring team review and approval.
Required Certification- Current credential as a CPC (Certified Professional Coder) or CCS (Certified Coding Specialist).
