Business Analyst – Consultant (Reference Administration)

Job Title: Business Analyst – Consultant (Reference Administration) (10851)

Location: Columbia, SC (Remote – Candidate must be SC resident)

Duration: 12 Months (Extension Possible)

Interview: 1 Round – Virtual

Key Responsibilities
• Support medical code change lifecycle including analysis, validation, and implementation
• Research and document business rules, requirements, and process workflows
• Collaborate with policy owners, stakeholders, and IT teams for approvals and updates
• Act as SME for ICD-10, CPT, and HCPCS coding methodologies
• Analyze and resolve complex MMIS-related issues
• Participate in MMIS enhancements and process improvement initiatives
• Facilitate stakeholder meetings and communicate across technical and non-technical teams
• Maintain documentation repository for business requirements and coding changes
• Ensure updates result in accurate claims adjudication outcomes
• Support training documentation and knowledge transfer activities

Required Skills & Experience
• Bachelor’s degree in Health Information, Healthcare Administration, or related field
• OR equivalent experience with 3+ years of supervisory experience
• 5+ years in healthcare insurance (medical review, program integrity, or appeals)
• 5+ years working with IT developers/programmers in a payer environment
• 5+ years of medical coding experience (payer side)
• 3+ years clinical experience in a healthcare setting
• Strong knowledge of ICD-10, CPT, HCPCS coding and translation methodologies
• Experience with business analysis, requirements gathering, and documentation
• Strong analytical, problem-solving, and communication skills
• Ability to manage multiple priorities and deadlines

Preferred Skills
• 5+ years experience in policy remediation
• Experience with medical claims processing systems
• Familiarity with tools such as:
• Microsoft Office (Excel, Word, PowerPoint)
• Optum Encoder or other coding tools

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