IT Clinical Analyst

The IT Healthcare Consultant - Business Analyst (Clinical and Coding Specialist) serves as a subject matter expert supporting Medicaid systems, medical coding processes, and policy-driven initiatives. This role focuses on analyzing and implementing coding updates, supporting MMIS enhancements, and advising policy and process stakeholders. The position combines clinical knowledge, coding expertise, and business analysis to ensure accurate claims adjudication and alignment with regulatory requirements. Key Responsibilities Medical Coding & Policy Support

• Support CPT, HCPCS, and ICD-10 code maintenance including annual and quarterly updates
• Review code changes to determine scope, impact, and required system updates
• Prepare code change documentation for review by program and policy staff
• Ensure alignment of coding changes with Medicaid policy and claims adjudication processes

MMIS Analysis & Business Support

• Serve as a subject matter expert for Medicaid systems, coding methodologies, and policy requirements
• Research and analyze business rules, requirements, and process models
• Maintain repositories of business rules, requirements, and system logic
• Provide recommendations to stakeholders to support decision-making and system improvements

Clinical & Analytical Evaluation

• Apply clinical knowledge to support medical coding and policy interpretation
• Assist with review of patient records to determine medical necessity when required
• Ensure coding and system updates result in accurate claims processing outcomes

Stakeholder Collaboration & Project Participation

• Conduct meetings with stakeholders, agency staff, and process owners
• Collaborate with IT developers, policy staff, and operational teams
• Participate in system enhancement and modernization initiatives
• Support process improvements and ongoing program initiatives

Documentation, Reporting & Governance

• Maintain process documentation, training materials, and coding guidelines
• Ensure documentation is complete, accurate, and up to date
• Support reporting and communication of coding updates and system changes
• Contribute to governance, compliance, and policy alignment efforts

Do you have experience in Research?, Do you have a Associate’s degree?, Candidate must be a South Carolina resident Must be comfortable working Eastern Time Zone hours Experience Level Senior Level (5 or more years of relevant experience), * Bachelor of Science in Nursing or Associate Degree in Nursing

• Active, unrestricted Registered Nurse license in South Carolina
• Current certification as Certified Professional Coder or Certified Coding Specialist
• Demonstrated ICD-10 proficiency or ability to obtain certification within one year
• 5 or more years of experience in healthcare insurance, medical review, program integrity, or appeals
• 5 or more years of experience working with IT developers or programmers in a payer environment
• 5 or more years of experience performing medical coding in a payer environment
• 3 or more years of clinical experience in a healthcare setting
• 5 or more years of experience with ICD, CPT, and HCPCS coding methodologies
• Strong knowledge of anatomy, physiology, pharmacology, and medical terminology
• Strong written and verbal communication skills
• Proficiency with Microsoft Office tools, * 5 or more years of experience supporting policy remediation initiatives
• 5 or more years of experience working with medical claims processing systems
• 5 or more years of experience with Optum Encoder or similar coding software
• Experience supporting government or managed care environments

Core Skills & Attributes

• Strong analytical and critical thinking capabilities
• Ability to manage multiple concurrent work efforts
• Excellent communication and stakeholder engagement skills
• Strong collaboration and relationship-building abilities
• High attention to detail and accuracy in coding and documentation
• Ability to work effectively in a fast-paced, change-oriented environment

• Competitive salary