IT Healthcare Consultant - Business (SC127710)R

IT Healthcare Consultant - Business (SC127710)R

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.

10+ 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