Healthcare policy and analyst Job at RICEFW Technologies Inc, Columbia, SC

SWRwaE8vWHhKTDR3MVBMeWcyeXdOVTgyWGc9PQ==
  • RICEFW Technologies Inc
  • Columbia, SC

Job Description

Job Description: ***Please read this request in detail - the following are needed - please do not submit candidates that do not have everything listed.**


Current nursing license in South Carolina and/or multi-State license AND Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.



SCOPE OF THE PROJECT:
This project is a multi-year effort which primarily focuses on providing consulting services to operations and policy staff for the current MMIS.


The current position's focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers. A long-term plan includes participating and providing guidance in the administrative approach for the replacement management system. It is necessary to build and sustain a strong Medical Coding staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and applies the codes correctly within the Reference Administration sub-system.


OBJECTIVES TO BE FULFILLED BY CANDIDATE:
The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance.


Specific duties include, but are not limited to:
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 codes 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 DASH (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.
Researches 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.
Other project-related duties.



REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
5 years' experience in healthcare insurance; medical review, program integrity, or appeals.
5 years' experience working with IT developers/programmers in a payor environment.
5 years' experience Medical Coding in payer environment.
3 years' clinical experience in a healthcare environment
Strong knowledge of ICD/CPT/HCPCS translation.
Strong knowledge of ICD/CPT/HCPCS coding methodologies.


Extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.


Superb written and oral communications skills, strong proficiency in English is required.


Strong knowledge of formal business process documentation.


Ability to effectively communicate with executive management, line management, project management, and team members.



PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
Experience in policy remediation.


Claims processing systems experience.


Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and or other medical coding software programs).


REQUIRED EDUCATION:
RN or LPN/Medical Coding Certification


REQUIRED CERTIFICATIONS:
Current nursing license in South Carolina and/or multi-State license AND Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.
Additional Sills: Strong knowledge of ICD/CPT/HCPCS translation (required, expert, currently using, 6+years); Extensive knowledge of anatomy, physiology, pharmacology, and medical terminology (required, expert, currently using, 6+years); Experience in policy remediation (preferred, expert, currently using 6+years) Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and or other medical coding software programs)(preferred, currently using, 6+years); RN or LPN/Medical Coding certification (required, expert, currently using, 6+years); Current nursing license in South Carolina and/or multi-State license. Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment. (required, expert, currently using)

Skills:

Category

Name

Required

Importance

Level

Last Used

Experience

Administrative Verbal Communication Skills Yes 1 Expert Currently Using 6 + Years
Administrative Written Communication Skills Yes 1 Expert Currently Using 6 + Years
Financial Claims Payment and Financial systems No 1 Expert Currently Using 6 + Years
Miscellaneous Interpret business process and business data models Yes 1 Expert Currently Using 4 - 6 Years
Nursing Clinical experience as a registered nurse or nurse practitioner. Yes 1 Expert Currently Using 2 - 4 Years
Packaged Applications Microsoft Office Suite No 1 Expert Currently Using 6 + Years
Specialties Knowledge and experience in healthcare insurance payment methodologies. Yes 1 Expert Currently Using 4 - 6 Years
Specialties Medicaid or healthcare experience Yes 1 Expert Currently Using 4 - 6 Years
Specialties Medical Coding Yes 1 Expert Currently Using 4 - 6 Years
Specialties Strong knowledge of ICD/CPT/HCPCS coding methodologies Yes 1 Expert Currently Using 6 + Years
Specialties Healthcare Claims Processing No 1 Expert Currently Using 6 + Years

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Report this job
  • Dice Id: 10480008
  • Position Id: 2024-38719

Job Tags

Remote job, Contract work,

Similar Jobs

XPO

Mechanic Apprentice Job at XPO

 ...What youll need to succeed as a Mechanic Apprentice at XPO Minimum qualifications: ~1 year of experience in tractor and trailer inspection and repair -OR- a technical school degree with certification in heavy-duty truck/trailer maintenance ~ A valid drivers license... 

LHH

CNC Machinist Job at LHH

 ...will be on first shift (6-2pm). No certain timeframe for training, depends on the individual*** Who it reports to: Reports to Machine Shop Supervisor CNC Machinist DMU -new position because they have a new machine ~3 years related experience and/or training.... 

Kelly

Medical Device Assembler Job at Kelly

 ...Kelly Engineering Services, in partnership with Johnson & Johnson based in Irvine, CA, is currently hiring Medical Device Assemblers to support new product development and meet production demands. Since 1886, Johnson & Johnson has led the way in developing life-saving... 

National Health Partners

Rheumatology - Florida Job at National Health Partners

 ...with more than 400 physicians practicing over 50 of specialties in over 25 office locations Outstanding opportunity to join our Rheumatology team Compensation & Benefit Package ~ Competitive Base Salary & Bonus Incentive Opportunity Retirement Savings... 

Extreme Youth Sports Tampa Bay

Certified Teacher Job at Extreme Youth Sports Tampa Bay

Job Description Job Description We are seeking a passionate and experienced educator to provide exceptional part-time home school instruction to our k-12 grade students. The ideal candidate will create a stimulating and nurturing learning environment that fosters academic...