Healthcare Business Analyst
Job Description Job Description SunPlus Data Group is looking for a Healthcare Business Analyst to work for a State Government facility in Columbia, SC.
THIS POSITION IS HYBRID (2 days on site) This is for 12
months and will likely extend.
Hours are generally M-F, 40 hrs/week.
Pay Rate is W2 $79 Benefit options such as health, dental, vision & PTO available 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 positions 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.
Research 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 15 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.
Strong knowledge of ICD/CPT/HCPCS translation.
Strong knowledge of ICD/CPT/HCPCS coding methodologies.
Company Description SunPlus Data Group is a company whose senior management has logged more than 60 man-years in managing Projects, Software engineering, production, and supply chain processes in Government, Aerospace / Aviation, Defense, Healthcare, Manufacturing, Energy, and Communications industries.
SunPlus offers market-tested industry-specific solutions and consulting services ranging from project portfolio management, program management, business process automation, business intelligence, and advanced analytics to staffing and outsourcing.
Over the last 20 years, SunPlus Data Group has grown from a five-person technology company to a full-blown consulting and project management consultancy firm.
SunPlus consultants have logged thousands of billable hours working with diverse clients nationwide.
SunPlus Data Group, Inc is an SBA 8(a) Certified, GSA schedule holder and Minority Owned firm based in Atlanta, GA providing services to our clients all over the United States.
Company Description SunPlus Data Group is a company whose senior management has logged more than 60 man-years in managing Projects, Software engineering, production, and supply chain processes in Government, Aerospace / Aviation, Defense, Healthcare, Manufacturing, Energy, and Communications industries.
SunPlus offers market-tested industry-specific solutions and consulting services ranging from project portfolio management, program management, business process automation, business intelligence, and advanced analytics to staffing and outsourcing.
rnrnOver the last 20 years, SunPlus Data Group has grown from a five-person technology company to a full-blown consulting and project management consultancy firm.
SunPlus consultants have logged thousands of billable hours working with diverse clients nationwide.
rnrnSunPlus Data Group, Inc is an SBA 8(a) Certified, GSA schedule holder and Minority Owned firm based in Atlanta, GA providing services to our clients all over the United States.
by Jobble Recommended Skills Administration Appeals Content Management Icd 10 Medical Classification Maintenance Management Systems Estimated Salary: $20 to $28 per hour based on qualifications.
THIS POSITION IS HYBRID (2 days on site) This is for 12
months and will likely extend.
Hours are generally M-F, 40 hrs/week.
Pay Rate is W2 $79 Benefit options such as health, dental, vision & PTO available 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 positions 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.
Research 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 15 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.
Strong knowledge of ICD/CPT/HCPCS translation.
Strong knowledge of ICD/CPT/HCPCS coding methodologies.
Company Description SunPlus Data Group is a company whose senior management has logged more than 60 man-years in managing Projects, Software engineering, production, and supply chain processes in Government, Aerospace / Aviation, Defense, Healthcare, Manufacturing, Energy, and Communications industries.
SunPlus offers market-tested industry-specific solutions and consulting services ranging from project portfolio management, program management, business process automation, business intelligence, and advanced analytics to staffing and outsourcing.
Over the last 20 years, SunPlus Data Group has grown from a five-person technology company to a full-blown consulting and project management consultancy firm.
SunPlus consultants have logged thousands of billable hours working with diverse clients nationwide.
SunPlus Data Group, Inc is an SBA 8(a) Certified, GSA schedule holder and Minority Owned firm based in Atlanta, GA providing services to our clients all over the United States.
Company Description SunPlus Data Group is a company whose senior management has logged more than 60 man-years in managing Projects, Software engineering, production, and supply chain processes in Government, Aerospace / Aviation, Defense, Healthcare, Manufacturing, Energy, and Communications industries.
SunPlus offers market-tested industry-specific solutions and consulting services ranging from project portfolio management, program management, business process automation, business intelligence, and advanced analytics to staffing and outsourcing.
rnrnOver the last 20 years, SunPlus Data Group has grown from a five-person technology company to a full-blown consulting and project management consultancy firm.
SunPlus consultants have logged thousands of billable hours working with diverse clients nationwide.
rnrnSunPlus Data Group, Inc is an SBA 8(a) Certified, GSA schedule holder and Minority Owned firm based in Atlanta, GA providing services to our clients all over the United States.
by Jobble Recommended Skills Administration Appeals Content Management Icd 10 Medical Classification Maintenance Management Systems Estimated Salary: $20 to $28 per hour based on qualifications.
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