HCPCS Analyst

Job Details

• Requirement ID: 158239
• Location: Columbia, SC (Fully Remote; Candidate MUST be a SC resident)
• Job Type: Contract
• Duration: 12 Months
• Start Date: 6/23/2026
• Compensation: DOE
• Submission Deadline: 05/27 at 5:00 PM EST

Job Description

The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. As the IT Healthcare Consultant -- Business Analyst -- Advanced (Clinical Analyst and Coding Specialist), you will serve as an agency subject matter expert for medical coding methodologies, Medicaid policy, and related topics.

Key Responsibilities

• Initiate annual and quarterly updates from CMS of all ICD-10, CPT/HCPCS coding changes.
• Perform initial review of codes to determine the scope of changes.
• Prepare listings of code changes for Reference Administration and Medicaid Program staff.
• Conduct meetings with Agency personnel, stakeholders, and process owners.
• Participate in DASH (Replacement MMIS) project meetings as needed.
• Research business rules, requirements, and models to complete analysis and recommendations.
• Maintain business rules, requirements, and models in a repository.
• Collaborate with the team to ensure process documentation and training content are complete and updated.
• May serve as a back-up to review patient records against established criteria to determine medical necessity.
• Other project-related duties.

Required Skills

• 5+ years in healthcare insurance (medical review, program integrity, or appeals).
• 5+ years working with IT developers/programmers in a payor environment.
• 5+ years medical coding in a payer environment.
• 3+ years clinical experience in a healthcare 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.
• 5+ years written and oral communications skills; strong proficiency in English.
• Knowledge of Microsoft Office Suite.

Preferred Skills

• 5+ years experience in policy remediation.
• 5+ years claims processing systems experience.
• 5+ years Optum Encoder and/or other medical coding software programs.

Required Education & Certifications

• Education: Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN).
• Licensure: Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
• Certification: Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.

Application Information

• Interview Process: 1 round, Virtual/Online.
• Contact: Call 502-379-4456 Ext 100 for more details. Please provide Requirement ID: 158239.

EOE Protected Veterans/Disability