Job Description: ***Please read this request in detail - the following are needed - please do not submit candidates that do not have everything listed.**

Current nursing license in South Carolina and/or multi-State license AND 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.

SCOPE OF THE PROJECT:
This project is a multi-year effort which primarily focuses on providing consulting services to operations and policy staff for the current MMIS.

The current position's focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers. A long-term plan includes participating and providing guidance in the administrative approach for the replacement management system. It is necessary to build and sustain a strong Medical Coding staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and applies the codes correctly within the Reference Administration sub-system.

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:
Initiates annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
Performs initial review of codes to determine scope of changes.
Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis.
Conducts meetings with Agency personnel, stakeholders, and process owners.
(Future) Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
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.
Other project-related duties.

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
5 years' experience in healthcare insurance; medical review, program 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 knowledge of ICD/CPT/HCPCS translation.
Strong knowledge of ICD/CPT/HCPCS coding methodologies.

Extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.

Superb written and oral communications skills, strong proficiency in English is required.

Strong knowledge of formal business process documentation.

Ability to effectively communicate with executive management, line management, project management, and team members.

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
Experience in policy remediation.

Claims processing systems experience.

Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and or other medical coding software programs).

REQUIRED EDUCATION:
RN or LPN/Medical Coding Certification

REQUIRED CERTIFICATIONS:
Current nursing license in South Carolina and/or multi-State license AND 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.
Additional Sills: Strong knowledge of ICD/CPT/HCPCS translation (required, expert, currently using, 6+years); Extensive knowledge of anatomy, physiology, pharmacology, and medical terminology (required, expert, currently using, 6+years); Experience in policy remediation (preferred, expert, currently using 6+years) Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and or other medical coding software programs)(preferred, currently using, 6+years); RN or LPN/Medical Coding certification (required, expert, currently using, 6+years); Current nursing license in South Carolina and/or multi-State license. 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. (required, expert, currently using)