What are the responsibilities and job description for the Lead Reference Administration Business Analyst position at Cynet Systems?
Job Description:
Pay Range: $60hr - $70hr
Pay Range: $60hr - $70hr
- 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.
- Researches 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.
- Five years’ experience in healthcare insurance; medical review, program integrity, or appeals.
- 5 years’ experience working with IT developers/programmers in a payor environment.
- 5 years’ experience Medical Coding in payer environment.
- Strong knowledge of ICD/CPT/HCPCS translation.
- Strong knowledge of ICD/CPT/HCPCS coding methodologies.
- Extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.
- Superb written and oral communications skills.
- Strong knowledge of formal business process documentation.
- Ability to effectively communicate with executive management, line management, project management, and team members.
- Experience in policy remediation.
- Claims processing systems experience.
- Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and or other medical coding software programs).
- Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
- ICD-10 Proficiency demonstrated by exam.
Salary : $60 - $70
