IT Healthcare Consultant - Business Analyst - Advanced (SC90801050)
Required Skills:
Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
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.
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 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.
Preferred Skills:
5+ years’ experience in policy remediation.
5+ years claims processing systems experience.
5+ years knowledge of Microsoft Office
5+ years Optum Encoder and/or other medical coding software programs