Business Analyst - Clinical Analyst & Coding Specialist
United States
Full-time
Remote
1 month ago
About the role
Pinnacle Method Consulting's mission is to help job seekers reach their career peak by accessing top-tier opportunities. We are not a staffing firm or agency. Pinnacle Method does not hire for these roles—we systematically source and verify them from premier employers.
Employer Industry: Healthcare Insurance
Why Consider This Job Opportunity
What To Expect (Job Responsibilities)
What Is Required (Qualifications)
How To Stand Out (Preferred Qualifications)
#HealthcareInsurance #MedicalCoding #CareerOpportunity #PolicyDevelopment #HealthcareProjects
"We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."
#PinnacleMethodConsulting
Employer Industry: Healthcare Insurance
Why Consider This Job Opportunity
- Opportunity for career advancement and growth within the organization
- Work as a subject matter expert in medical coding methodologies and Medicaid policy
- Engaging in collaborative meetings with agency personnel and stakeholders
- Chance to contribute to meaningful healthcare projects and policy updates
- Supportive work environment focused on continuous improvement and training
What To Expect (Job Responsibilities)
- Assist with CPT/HCPCS and ICD-10 code maintenance, including annual updates from CMS
- Perform initial reviews of codes to determine the scope of changes and prepare listings for analysis
- Conduct meetings with agency personnel, stakeholders, and process owners to discuss coding changes
- Research business rules, requirements, and models to complete initial analysis and recommendations
- Collaborate with the team to ensure process documentation is complete and training content is updated
What Is Required (Qualifications)
- Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
- Current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse
- Credentialed as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist); ICD-10 proficiency demonstrated by exam or able to become certified within one year of employment
- Minimum of 5 years of experience in healthcare insurance, medical review, program integrity, or appeals
- Minimum of 5 years of medical coding experience in a payer environment
How To Stand Out (Preferred Qualifications)
- 5+ years of experience in policy remediation
- 5+ years of claims processing systems experience
- 5+ years of experience with Optum Encoder or other medical coding software programs
#HealthcareInsurance #MedicalCoding #CareerOpportunity #PolicyDevelopment #HealthcareProjects
"We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."
#PinnacleMethodConsulting
Skills
AnalystIT Services and IT Consulting