Systems Software Programmer - Consultant

Job Overview: The consultant will serve as a medical coding SME, supporting CPT/HCPCS and ICD-10 code maintenance, researching coding changes, analyzing business rules, working with Medicaid program stakeholders, and supporting current and future MMIS enhancements. The SOW specifically identifies this position as being focused on a Certified Medical Coder supporting South Carolina Medicaid. Key Responsibilities

• Manage annual and quarterly ICD-10 and CPT/HCPCS coding updates from CMS.
• Review coding changes and determine their impact on Medicaid policies and processes.
• Prepare code-change documentation for Medicaid program and reference administration teams.
• Serve as an SME for medical coding methodologies, Medicaid policy, and healthcare processes.
• Research and document business rules, requirements, and recommendations.
• Collaborate with policy owners, stakeholders, IT developers, and project teams.
• Support MMIS enhancements and future MMIS replacement/DASH initiatives.
• Assist with medical necessity reviews when required.

• BSN or ADN required.
• Current, active, unrestricted South Carolina Registered Nurse license - mandatory.
• Current CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential.
• ICD-10 proficiency demonstrated by exam, or ability to obtain certification within one year.
• 10+ years healthcare insurance experience involving medical review, program integrity, or appeals.
• 5+ years working with IT developers/programmers in a payer environment.
• 5+ years medical coding experience in a payer environment.
• 3+ years clinical healthcare experience with strong clinical assessment and critical-thinking skills.
• 5+ years knowledge of ICD/CPT/HCPCS coding and translation methodologies.
• 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.

Preferred Skills

• 5+ years policy remediation experience.
• 5+ years claims processing systems experience.
• 5+ years Microsoft Office experience.
• 5+ years with Optum Encoder or similar medical coding software.

InterSources Inc , is a Small, Woman, and Minority-Owned Business Enterprise, ISO/IEC 27001, SOC 2 Type 2 certified company with massive 18+ years of diversified experience in providing IT Consulting Services, Artificial Intelligence, Data Analysis, Application Development, Cloud Services, Cybersecurity, Digital Marketing, ERP Management, Custom Software Development, Web Development, UI/ UX Design, System Integration, QA Support etc. We make reasonable accommodations for clients and employees, and we do not discriminate based on any protected attribute including race, religion, color, national origin, gender sexual orientation