RN Clinical Coding Analyst

Job Title: IT Healthcare Consultant – Business Analyst - Advanced (Clinical Analyst & Coding Specialist) Location: Columbia, SC (Fully Remote – Candidate must reside in South Carolina) Duration: 12 Months (Possible Extension) Interview Process: 1 Round – Virtual/Online Key Responsibilities • Initiate annual and quarterly ICD-10, CPT, and HCPCS coding updates from CMS • Review and analyze coding changes to determine business and operational impacts • Prepare code change listings for Reference Administration and Medicaid Program teams • Conduct meetings with agency personnel, stakeholders, and process owners • Serve as SME for medical coding methodologies and Medicaid policy • Research business rules, requirements, and models to provide recommendations • Maintain business rules and documentation repositories • Collaborate with teams to ensure documentation and training materials are updated • Participate in MMIS enhancement and future replacement initiatives • Support medical necessity reviews when required • Assist with process improvement initiatives and project-related activities Required Skills • Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN) • Active, unrestricted South Carolina Registered Nurse (RN) license • CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification • ICD-10 proficiency certification or ability to obtain within one year • 5+ years healthcare insurance experience (medical review, appeals, or program integrity) • 5+ years working with IT developers/programmers in a payer environment • 5+ years medical coding experience in payer environment • 3+ years clinical healthcare experience with strong assessment skills • 5+ years knowledge of ICD/CPT/HCPCS coding methodologies • Strong understanding of anatomy, physiology, pharmacology, and medical terminology • Strong analytical, communication, collaboration, and relationship-building skills • Experience managing multiple work efforts simultaneously • Ability to write and understand business and functional requirements Preferred Skills • 5+ years policy remediation experience • 5+ years claims processing systems experience • Experience with Optum Encoder and other medical coding software programs • Government operations and managed care background preferred Additional Information • Fully Remote role; however, candidate must currently reside in South Carolina • No relocation permitted