Business Analyst (Policy remediation) - Contract - Remote

Business Analyst (Policy remediation)
Location:Remote

Interview Process:1 round, virtual

Duration:12Months
Employment Type: Contract
Experience Required: 05+ Years

Candidate Location: CandidateMUST be a SC resident. No relocation allowed.

Project Scope:

We are seeking an experienced Business Analystwith expertise in policy remediation, medical coding, and healthcare claimssystems. This role will serve as a subject matter expert (SME) supportingpolicy and operational initiatives related to medical coding compliance, claimsadjudication, and system change management.

The ideal candidate will leverage deepknowledge of ICD-10, CPT, and HCPCS coding methodologies, as well as Medicaidand payer operations, to ensure alignment between policy updates, codingchanges, and system functionality. This position will play a critical role insupporting compliance initiatives, regulatory updates, and business processimprovements.

Key Responsibilities:

• Serve as asubject matter expert (SME) for medical coding methodologies, Medicaid policy,and claims adjudication processes.
• Analyze annual,quarterly, and ad hoc coding updates, including ICD-10, CPT, and HCPCS changes.
• Review and assessthe impact of coding and policy changes on business processes, systemfunctionality, and claims outcomes.
• Collaborate withbusiness stakeholders, policy teams, and technical teams to define requirementsand implement necessary system changes.
• Support changerequests and ensure system updates produce accurate and expected claimsadjudication results.
• Research businessrules, requirements, and process models to develop recommendations andsolutions.
• Maintain andupdate business rules, requirements documentation, and process models indesignated repositories.
• Lead meetingswith stakeholders, business owners, and cross-functional teams.
• Participate inpolicy remediation efforts, compliance initiatives, and related enterpriseprojects.
• Ensure processdocumentation, training materials, and supporting documentation are completeand up to date.
• Collaborate withinternal teams to support ongoing operational and regulatory compliance.
• Provide expertisein medical coding software, claims systems, and healthcare policyinterpretation.

Required Skills & Experience:

• Minimum of 5years of experience in healthcare insurance, medical review, program integrity,or appeals.
• At least 5 yearsof experience working with IT developers and programmers in a payerenvironment.
• Minimum of 5years of hands-on experience in medical coding within a payer environment.
• Strong expertisein ICD-10, CPT, and HCPCS coding methodologies and translation.
• Minimum of 5years of experience with medical claims processing systems.
• Proficiency withMicrosoft Office Suite (Word, Excel, PowerPoint).
• Experience usingOptum Encoder or similar medical coding software.
• Stronganalytical, problem-solving, and critical-thinking skills.
• Excellent writtenand verbal communication skills.

Preferred Skills:

• Minimum of 5years of experience in policy remediation.
• At least 3 yearsof clinical experience in a healthcare environment.
• Strong clinicalassessment and critical-thinking skills.
• Experience withMedicaid programs and Medicaid Management Information Systems (MMIS).
• Familiarity withhealthcare regulatory compliance and policy implementation.

TechnicalSkills

MedicalCoding and Reimbursement, ICD-10, CPT, and HCPCS Expertise, Policy Remediationand Compliance, Claims Adjudication and Processing, Medicaid and MMIS Knowledge,Business Requirements Analysis, Process Documentation and Improvement, StakeholderEngagement and Facilitation, Regulatory and Operational Compliance, Cross-FunctionalCollaboration

Education:

Bachelor’s degree in Health InformationManagement, Healthcare Administration, Business, or a related field.