Medicaid Coding Specialist

Summary

Direct End Client: State of South Carolina

Job Title: Medicaid Coding Specialist

Location: Columbia SC 29210 (Hybrid)

Duration: 12 Months

Position Type: Contract

Hours Per Week: 40 Hr

Interview Mode: Webcam or In-Person

Ceipal ID: SSC_MEDI856_AK

Requirement ID: 13856

Department: South Carolina Department of Health & Human Services (SCDHHS)

Note: 80% remote, resources will need to come onsite in Columbia, SC to certain trainings/meetings

Scope of The Project:

This project is a multi-year-old effort which primarily focuses on providing consulting services to operations and policy staff for the current Medicaid Management Information System (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. It is necessary to build and sustain a strong staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and apply the codes correctly within the Reference Administration sub-system.

Responsibilities:

• 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.
• May serve as a back-up to other roles within the bureau to support claim escalations research, once the person has demonstrated full proficiency in the job functions required for their new role
• Other project-related duties, as assigned or required

Required Skills:

• 3+ years' experience in healthcare
• Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
• 3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
• 3+ years of strong knowledge of formal business process documentation.
• Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).

Preferred Skills, Education and/or Certifications:

• 3+ years' experience healthcare hospital, office and clinic setting
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
• Other: preference for resources that are local to SC, NC, or GA. Resources can reside anywhere in the US - but must be willing to travel onsite to Columbia, SC within notice from management at the resources expense.
• Bachelor's degree in healthcare related field. An equivalent combination of experience and education may be considered with prior SCDHHS hiring team review and approval.

V Group Inc. is a NJ-based IT Services and Products Company with its business strategically categorized in various Business Units including Public Sector, Enterprise Solutions, Professional Services, Ecommerce, Projects, and Products. Within Public Sector business unit, we cater IT Professional Services to Federal, State and Local. We have multiple awards/ contracts with 30+ states, including but not limited to NY, CA, FL, GA, MD, MI, NC, OH, OR, CO, CT, TN, PA, TX, VA, NM, VT, and WA.

If you are considering applying for a position with V Group, or in partnering with us on a position, please feel free to contact me for any questions you may have regarding our services and the advantages we can offer you as a consultant.

Please share my contact information with others working in Information Technology.

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Job Description

Direct End Client: State of South Carolina

Job Title: Medicaid Coding Specialist

Location: Columbia SC 29210 (Hybrid)

Duration: 12 Months

Position Type: Contract

Hours Per Week: 40 Hr

Interview Mode: Webcam or In-Person

Ceipal ID: SSC_MEDI856_AK

Requirement ID: 13856

Department: South Carolina Department of Health & Human Services (SCDHHS)

Note: 80% remote, resources will need to come onsite in Columbia, SC to certain trainings/meetings

Scope of The Project:

This project is a multi-year-old effort which primarily focuses on providing consulting services to operations and policy staff for the current Medicaid Management Information System (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. It is necessary to build and sustain a strong staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and apply the codes correctly within the Reference Administration sub-system.

Responsibilities:

• 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.
• May serve as a back-up to other roles within the bureau to support claim escalations research, once the person has demonstrated full proficiency in the job functions required for their new role
• Other project-related duties, as assigned or required

Required Skills:

• 3+ years' experience in healthcare
• Strong knowledge of ICD/CPT/HCPCS translation and coding methodologies
• 3+ years extensive knowledge of anatomy, physiology, pharmacology, and medical terminology
• 3+ years of strong knowledge of formal business process documentation.
• Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).

Preferred Skills, Education and/or Certifications:

• 3+ years' experience healthcare hospital, office and clinic setting
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and other medical coding software programs)
• Other: preference for resources that are local to SC, NC, or GA. Resources can reside anywhere in the US - but must be willing to travel onsite to Columbia, SC within notice from management at the resources expense.
• Bachelor's degree in healthcare related field. An equivalent combination of experience and education may be considered with prior SCDHHS hiring team review and approval.

V Group Inc. is a NJ-based IT Services and Products Company with its business strategically categorized in various Business Units including Public Sector, Enterprise Solutions, Professional Services, Ecommerce, Projects, and Products. Within Public Sector business unit, we cater IT Professional Services to Federal, State and Local. We have multiple awards/ contracts with 30+ states, including but not limited to NY, CA, FL, GA, MD, MI, NC, OH, OR, CO, CT, TN, PA, TX, VA, NM, VT, and WA.

If you are considering applying for a position with V Group, or in partnering with us on a position, please feel free to contact me for any questions you may have regarding our services and the advantages we can offer you as a consultant.

Please share my contact information with others working in Information Technology.

Website:

LinkedIn:

Facebook:

Twitter: