Clinical Analyst

About the Role

Our Client, a leading state healthcare agency, is seeking an experienced Clinical Analyst to join their IT Healthcare team. In this role, you will serve as a critical bridge between clinical operations and technical systems, specifically focusing on the Medicaid Management Information System (MMIS). You will be responsible for analyzing medical code change requests, providing subject matter expertise, and driving process improvements that enhance the efficiency of healthcare data management. This position is ideal for a professional with a strong background in healthcare and certified medical coding experience who thrives in a dynamic, change-oriented environment. Your work will directly impact the accuracy of medical billing and the strategic planning for future system enhancements.

Key Responsibilities

• Research and analyze medical code change requests to ensure compliance with current healthcare regulations and internal policies.
• Develop and present recommendations to policy owners and stakeholders for review and approval regarding clinical coding standards.
• Provide subject matter expertise (SME) for the current MMIS and contribute to the strategic planning for a future MMIS replacement.
• Collaborate with cross-functional project teams to identify and implement process improvements within the Reference Administration team.
• Monitor healthcare industry trends and regulatory changes to proactively update clinical coding guidelines and system configurations.
• Support the finalization of succession planning for the Reference Administration team by documenting processes and mentoring junior staff.
• Coordinate with IT and clinical departments to resolve complex data discrepancies and ensure accurate reporting.
• Participate in training sessions and meetings to disseminate new coding protocols and system updates to relevant stakeholders.

Required Skills & Experience

• Certified Medical Coder (e.g., CPC, CCS, or equivalent certification) is mandatory.
• Proven experience as a Business Analyst or Clinical Analyst within the healthcare sector, specifically with Medicaid or MMIS systems.
• Strong understanding of medical coding standards (ICD-10, CPT, HCPCS) and their application in state-level healthcare systems.
• Excellent analytical skills to interpret complex clinical data and translate it into actionable technical requirements.
• Strong communication skills to effectively present findings and recommendations to non-technical stakeholders and policy owners.
• Experience in process improvement and change management within a large-scale our client or healthcare organization.

Tools & Technologies

• Medicaid Management Information System (MMIS) platforms.
• Medical coding software and databases (ICD-10, CPT, HCPCS).
• Microsoft Office Suite (Excel, Word, PowerPoint) for data analysis and reporting.
• Project management tools for tracking code change requests and process improvements.

Work Schedule & Duration

• Contract Duration: 12 months with the possibility of extension.
• Work Arrangement: 80% Remote / 20% Onsite.
• Onsite Requirements: Candidates must be willing to travel to Columbia, SC for specific trainings and meetings at their own expense.
• Location Preference: Candidates residing in South Carolina, North Carolina, or Georgia are strongly preferred.

Interview Process

The interview process consists of one round, conducted virtually/online. Candidates should be prepared to discuss their experience with medical coding, MMIS systems, and specific examples of process improvements they have led or supported.

Position Details

• Employment Type: Contract
• Duration: Approximately 12 months (with potential for extension)
• Work Authorization: Must be authorized to work in the United States