Job Description

The Business Analyst Consultant will support the medical code

change requests by researching processes for policy and process owners and stakeholders for

review and approval and supporting the updates. The position will also participate as a

project team member, as assigned, for related process improvements, Medicaid Management

Information System (MMIS) enhancements and provide subject matter expertise for a future

roadmap and technology needs.

Investigate, define and resolve complex Medicaid Management Information System (MMIS)

issues. Maintain a thorough knowledge and understanding of MMIS procedure code and

associated pricing, provider/member relations and industry standards. Understand, foster,

and practice high customer service standards. Communicate complex information to both

technical and non-technical audiences. Facilitate collaboration between stakeholders.

Supervise staff responsible for MMIS updates. Establish milestones and assign staff tasks and

responsibilities. Analyze, design, plan, execute, and evaluate agency priorities and initiatives.

Candidates who enjoy working on complex, change-oriented projects with motivated team

members will find this position attractive.

WHY IS THIS POSITION OPEN (new role, increased workload, new dept., resignation, promotion)?

The workload and complexities of the reference administration responsibilities require

additional support to maintain efficiency and to achieve defined deliverable dates.

• This position requires an individual with strong analytical skills and experience in:

➢ Managing multiple work efforts simultaneously

➢ Medical Coding

➢ Time management skills

➢ CPT/HCPCS and ICD-10 translation

➢ Ability to write and understand business and functional

requirements.

➢ Medicaid Policy, coding changes, system functionality and

success implementation of changes for the expected outcome

• Please ensure that your candidates have strengths in these areas. Please do not

submit general Medical Coders with no structured background in business rules or

claims processing, preferably Government Operations and Managed Care

background.

• The candidate must have strong collaboration and relationship building skills.

• Experience in healthcare insurance.

SCOPE OF THE PROJECT:

This project is an immediate support need that will primarily focus on providing consulting

services to operations and policy staff for the current medical coding federal requirements,

quarterly and intermittently, and all coding changes associated with agency initiatives to

ensure compliance policy and code change alignment. Note - Medicaid Management

Information System (MMIS) is the system of record.

The current position’s focus and priority is the continued support of serving as a subject

matter expert (SME), utilizing knowledge of medical coding and MMIS to support change

requests while ensuring change requests and system updates result in the expected claims

adjudication outcomes for the benefit of Medicaid members and providers.

PRE-EMPLOYMENT CHECKS?

State mandatory - Criminal, Credit and E-Verify background checks

OBJECTIVES TO BE FULFILLED BY CANDIDATE:

The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code

maintenance.

Specific duties include, but are not limited to:

• Collaborates with internal recipient and owner of initial review of codes to determine

scope of changes for planning and timely completion.

• Receives listings of codes changes distributed to the Reference Administration and

Medicaid Program staff for review and analysis.

• Serves as an approver within the code change / update process following the internal

initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding

changes.

• Serves as lead for meetings with Agency personnel, stakeholders, and process

owners.

• Serves as an agency subject matter expert (SME) for medical coding methodologies,

Medicaid policy, and related topics.

• Researches business rules, requirements, and models to complete initial analysis and

recommendations.

• Maintains business rules, requirements, and models in a repository.

• Collaborates with team to ensure process documentation is complete, owner and

stakeholder, as needed, training content is complete and routinely updated.

• Participates in agency projects and related initiatives requiring subject matter

expertise.

• Other duties, as assigned or required.

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):

• 5 years’ experience in healthcare

insurance; medical review, program

PREFERRED SKILLS (RANK IN ORDER OF

IMPORTANCE):

• 5 years’ experience in policy

remediation.

integrity, or appeals.

• 5 years’ experience working with IT

developers/programmers in a payor

environment.

• 5 years’ experience Medical Coding in

payer environment.

• 3 years’ clinical experience in a

healthcare environment (Strong

clinical assessment and critical

thinking skills.)

• 5 years’ strong knowledge of

ICD/CPT/HCPCS translation and

coding methodologies.

• 5 years’ Medical Claim processing

systems experience.

• Knowledge of Microsoft Office

(Word, Excel, PowerPoint, Optum

Encoder and / or other medical

coding software programs).

REQUIRED EDUCATION:

Bachelor’s degree in Health Information,

Healthcare Administration, or related field;

equivalent experience may be considered

with a minimum of 3+ years of direct

supervisor experience.

ADDITIONAL SKILLS/DUTIES:

• Superb written and oral

communications skills, strong

proficiency in English.

• Strong knowledge of formal business

process documentation.

• Ability to effectively communicate

with executive management, line

management, project management,

and team members.

INTERVIEW PROCESS (who will conduct i/v,

phone or in-person, how many rounds of i/v)?

The interviews will be conducted by a

team either in-person or via video

conferencing.

SCHEDULE INTERVIEW: How soon can you

schedule an interview (date / times)?

Once qualified resumes and candidates have

been received.