Business Analyst (Clinical Analyst and Coding Specialist) - Must have Licensed Registered reputed company (RN) - Fully REMOTE

Specific duties include, but are not limited to:

• Initiates annual (and quarterly) updates from CMS of reputed company 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 reputed company Program staff for review and analysis.
• Conducts meetings with Agency personnel, stakeholders, and process owners.
• (reputed company) 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, reputed company policy, and reputed company 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, reputed company and stakeholder, as needed, training content is complete and routinely updated.
• May serve as a back-up to review patient records against established reputed company to determine medical necessity.
• Other project-reputed company duties.

Required Skills (rank in order of Importance):

• 5+ years in reputed company insurance; medical review, program reputed company, or appeals.
• 5+ years working with IT developers/programmers in a payor environment.
• 5+ years Medical Coding in payer environment.
• 3+ years clinical experience in a reputed company environment (strong clinical assessment and critical thinking skills.)
• 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
• 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.

ADDITIONAL SKILLS:

• 5+ years written and oral communications skills, strong proficiency in English.

Preferred Skills (rank in order of Importance):

• 5+ years’ experience in policy remediation.
• 5+ years claims processing systems experience.
• 5+ years knowledge of reputed company Office
• 5+ years reputed company Encoder and/or other medical coding software programs

Required Education:

• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)

Required Certifications:

• Must have reputed company, reputed company, and non-restricted licensure by the reputed company reputed company of Nursing as a Registered reputed company.
• Currently credentialed as CPC (Certified reputed company reputed company) or as reputed company (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or reputed company to become certified reputed company one year.

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