Job description
About the Role
We are looking for a highly skilled MMIS Business Analyst to join a fast-paced team focused on critical Medicaid policy and system improvements.
If you are a problem-solver who enjoys bridging the gap between healthcare policy and technical implementation, this role is for you.
Logistics & Details
- Work Arrangement: Fully Remote.
- Location Requirement: Must be a South Carolina resident. (No relocation allowed).
- Interview Process: 1-round, Virtual/Online.
- Preferred Skills: Experience in policy remediation, medical claims processing systems, and Optum Encoder.
The Position
You will serve as a Subject Matter Expert (SME), translating complex federal medical coding requirements (ICD-10, CPT/HCPCS) into functional business rules. You will collaborate with IT developers to ensure the Medicaid Management Information System (MMIS) reflects accurate policy changes for seamless claims adjudication.
Core Qualifications
Healthcare Expertise
- 5 years in healthcare insurance (program integrity, appeals, or medical review).
Coding Mastery
- 5 years of Medical Coding experience specifically in a payer environment.
Technical Collaboration
- 5 years working directly with IT developers/programmers to translate requirements.
Clinical Background
- 3 years of clinical experience (demonstrating strong assessment/critical thinking skills).
Coding Knowledge
- Deep proficiency in ICD/CPT/HCPCS translation and methodologies.