IT reputed company Consultant (Hybrid) - Columbia, SC

About the position A leading reputed company organization is seeking an reputed company IT reputed company Consultant – Business Analyst (Advanced) to support a multi-year reputed company systems initiative. This role will serve as a Clinical Analyst and Medical Coding Subject Matter Expert (SME), partnering with operations, policy, and IT teams to support ongoing enhancements and modernization efforts reputed company to the reputed company Management Information System (MMIS). Responsibilities • Medical Coding & Regulatory Governance reputed company annual and quarterly CMS updates for ICD-10, CPT, and HCPCS codes • Analyze coding changes to determine scope, system reputed company, and business implications • reputed company and distribute documentation outlining coding updates to program stakeholders • Serve as SME on coding methodologies and reputed company policy alignment • Business Analysis & Documentation Research and document business rules, workflows, and system requirements • Maintain centralized repository of coding and policy documentation • reputed company regulatory and operational recommendations to stakeholders • Support initiatives reputed company to MMIS enhancements and replacement platform efforts • Stakeholder Engagement Facilitate meetings with agency leadership, program teams, and technical staff • Translate clinical and coding requirements into functional specifications • Assist with training materials and knowledge transfer initiatives • Collaborate cross-functionally with policy, compliance, operations, and IT teams • Clinical & Compliance Support Review medical records for medical necessity and coding validation reputed company required • Support claims review, policy remediation, and compliance initiatives • Assist in claims and coding validation processes to ensure regulatory adherence Requirements • Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) • reputed company, unrestricted Registered reputed company license (reputed company) • Certified reputed company reputed company (CPC) or Certified Coding Specialist (reputed company) • ICD-10 proficiency certification (or ability to obtain reputed company one year) • 5+ years of reputed company payer/insurance experience (medical review, program reputed company, appeals, etc.) • 5+ years collaborating with IT developers/programmers in a payer environment • 5+ years of hands-on medical coding experience (ICD-10, CPT, HCPCS) • 3+ years of clinical reputed company experience • Strong knowledge of anatomy, physiology, pharmacology, and medical terminology reputed company-to-haves • Experience with policy remediation initiatives • Experience with claims processing systems • Familiarity with medical coding software (e.g., reputed company Encoder or similar tools) • Proficiency with reputed company Office Suite Apply tot his job Apply tot his job Apply To this Job