Senior Clinical Analyst

Senior Clinical Analyst – Healthcare / Medical Coding

Job ID: 13856

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

Location: Columbia, SC

Work Arrangement: 80% Remote / 20% Onsite as Required

Contract Duration: 2 Months

Extension: Possible

Interview: 1 Round – Virtual

About the Role

The South Carolina Department of Health & Human Services (SCDHHS) is seeking an experienced Clinical Analyst / Healthcare Business Analyst with a strong medical coding background to support its Medicaid Management Information System (MMIS) and Reference Administration activities.

The ideal candidate will have strong healthcare experience and hands-on knowledge of ICD-10, CPT, and HCPCS coding methodologies, preferably with an active CPC or CCS certification.

This role will serve as a subject matter expert supporting medical code changes, healthcare business processes, policy and process owners, and ongoing MMIS-related initiatives.

Key Responsibilities

Support annual and quarterly updates from CMS involving ICD-10, CPT, and HCPCS coding changes.Review medical code changes and determine the scope and potential business impact.Prepare code-change listings for Reference Administration and Medicaid Program staff for review and analysis.Research coding methodologies, business rules, requirements, and process models.Develop initial analysis and recommendations for policy and process owners.Serve as a subject matter expert on medical coding methodologies, Medicaid policy, and related healthcare processes.Conduct meetings with agency personnel, stakeholders, process owners, and project teams.Maintain business rules, requirements, models, and related documentation in designated repositories.Collaborate with stakeholders to ensure process documentation remains complete, accurate, and current.Support training content and knowledge-sharing activities related to medical coding and reference administration.Participate in MMIS enhancement and modernization initiatives as assigned.Participate in future MMIS replacement project activities and provide Reference Administration subject matter expertise as needed.Provide research support for claim escalations and related business processes after achieving proficiency in core responsibilities.Perform other project-related duties as assigned.Required Qualifications

Bachelor's degree in a healthcare-related field.3+ years of healthcare experience.Strong knowledge of ICD-10, CPT, and HCPCS coding methodologies.3+ years of extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.3+ years of experience with formal business process documentation.Strong written and verbal communication skills.Ability to communicate effectively with executive management, line management, project management, stakeholders, and technical teams.Strong analytical and research skills.Ability to work effectively in complex, change-oriented healthcare projects.Preferred Qualifications

Current CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification.3+ years of experience in healthcare hospital, office, or clinical settings.Experience with Microsoft Word, Excel, and PowerPoint.Experience with Optum Encoder or other medical coding software.Experience supporting Medicaid, healthcare policy, MMIS, claims, or reference administration processes.Experience with public-sector healthcare or government healthcare programs.Project Scope

This position supports the ongoing operations and modernization of the State's Medicaid Management Information System (MMIS).

The selected candidate will help maintain and support medical coding reference data, assist policy and process owners with CPT/HCPCS and ICD-10 changes, and provide subject matter expertise to ensure medical codes are researched, analyzed, maintained, and applied correctly.

The role may also support future MMIS replacement and modernization initiatives.

Work Arrangement

This position is approximately 80% remote. The selected resource must be available to travel to Columbia, South Carolina for required trainings, meetings, or other onsite activities with reasonable notice.

Candidates may reside anywhere in the United States but must be willing to travel onsite to Columbia, SC at their own expense when required.

Strong preference will be given to candidates currently located in South Carolina, North Carolina, or Georgia.

Ideal Candidate

The ideal candidate is a Clinical Analyst, Healthcare Business Analyst, Medical Coding Specialist, Clinical Coding Analyst, or Healthcare IT professional with strong hands-on knowledge of medical coding and healthcare processes.

Candidates with a combination of medical coding + healthcare business analysis + Medicaid/MMIS experience will be especially well aligned.