Business Analyst - Clinical Analyst & Coding Specialist - Contract - Remote
United States
Contract
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 Services
Why Consider This Job Opportunity
What To Expect (Job Responsibilities)
What Is Required (Qualifications)
How To Stand Out (Preferred Qualifications)
#HealthcareServices #MedicalCoding #RemoteWork #CareerOpportunity #HealthcareCompliance
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 Services
Why Consider This Job Opportunity
- Opportunity for career advancement and growth within the organization
- Fully remote position, providing flexibility in work location
- Work in a crucial role supporting Medicaid policy and healthcare initiatives
- Collaborative environment with cross-functional teams
- Chance to work as a subject matter expert in medical coding compliance and Medicaid operations
What To Expect (Job Responsibilities)
- Serve as a subject matter expert (SME) for medical coding methodologies, Medicaid policy, and healthcare claims processing
- Perform analysis of medical coding changes and assess their impact on business processes and claims adjudication
- Collaborate with policy owners, stakeholders, developers, and business teams to support change requests and MMIS enhancements
- Maintain business rules, coding documentation, and requirements repositories
- Facilitate meetings with agency personnel and operational teams
What Is Required (Qualifications)
- Minimum of 5 years of experience in healthcare insurance, medical review, program integrity, or appeals
- Minimum of 5 years of hands-on medical coding experience in a payer environment
- Minimum of 3 years of clinical experience in a healthcare environment
- Strong expertise in ICD-10, CPT, and HCPCS coding methodologies
- Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse
How To Stand Out (Preferred Qualifications)
- 5+ years of experience in policy remediation
- Experience using Optum Encoder and other medical coding software platforms
- Strong clinical assessment and critical-thinking skills
- Experience supporting government healthcare or managed care operations
#HealthcareServices #MedicalCoding #RemoteWork #CareerOpportunity #HealthcareCompliance
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