Business Analyst (Clinical Analyst And Coding Specialist) - Must Have Licensed

SkillSync
Department Icon Data Science Analytics & Machine Learning
Posted: 2 weeks ago
5-9 years
All India
Data Science Analytics & Machine Learning
work from home
Full Time
Closes 28 Dec 2026
Posted: 2 weeks ago
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Job Description

  • Business Analyst (Clinical Analyst and Coding Specialist) - Must have Licensed Registered Nurse (RN) - Fully REMOTE
  • Company: SkillSync
  • Job Location: Remote (Work from home), India
  • Employment Type: Full-time
  • Experience Required: 5+ years
  • 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.
  • May serve as a back-up to review patient records against established criteria to determine medical necessity.
  • Other project-related duties.
  • Required Skills (rank in order of Importance)
  • 5+ years in healthcare insurance; medical review, program integrity, or appeals.
  • 5+ years working with IT developers/programmers in a payor environment.
  • 5+ years Medical Coding in payer environment.
  • 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
  • 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
  • 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.
  • ADDITIONAL SKILLS
  • 5+ years written and oral communications skills, strong proficiency in English.
  • Preferred Skills (rank in order of Importance)
  • 5+ years experience in policy remediation.
  • 5+ years claims processing systems experience.
  • 5+ years knowledge of Microsoft Office
  • 5+ years Optum Encoder and/or other medical coding software programs
  • Required Education
  • Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
  • Required Certifications
  • Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
  • 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. .

Skills

Business AnalystAnalystMedical TerminologyBusiness RulesHCPCS CodingOral CommunicationCritical ThinkingMicrosoft OfficeMedical Coding MethodologiesMedicaid PolicyOptum EncoderClinical Assessment

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