Business Analyst - Healthcare Coding & MMIS

Job Title
Senior Business Analyst – Healthcare Coding & MMIS

Overview / Summary
The Business Analyst Consultant will support medical code change requests by researching processes, collaborating with stakeholders, and ensuring accurate updates within the Medicaid Management Information System (MMIS). This role serves as a subject matter expert in medical coding and Medicaid policy, contributing to system enhancements, process improvements, and successful implementation of coding changes.

Key Responsibilities

• Research and analyze medical code change requests for policy and process owners
• Investigate, define, and resolve complex MMIS issues
• Maintain knowledge of MMIS procedures, coding standards, and pricing methodologies
• Collaborate with stakeholders, technical teams, and business users to support system updates
• Communicate complex information to technical and non-technical audiences
• Facilitate stakeholder collaboration and lead meetings with agency personnel
• Supervise staff responsible for MMIS updates and assign tasks and milestones
• Analyze, design, plan, execute, and evaluate agency initiatives and priorities
• Serve as subject matter expert (SME) for medical coding methodologies and Medicaid policy
• Support CPT/HCPCS and ICD-10 code maintenance and updates
• Review and approve code changes based on CMS updates
• Research business rules, requirements, and models; provide analysis and recommendations
• Maintain documentation of business rules and process requirements
• Ensure process documentation and training materials are complete and up to date
• Participate in projects involving MMIS enhancements and process improvements
• Support claims adjudication outcomes through accurate system updates
• Perform additional duties as assigned

Required Qualifications

• Bachelor’s degree in Health Information, Healthcare Administration, or related field; or equivalent experience with 3+ years of direct supervisory experience
• 5+ years of experience in healthcare insurance (medical review, program integrity, or appeals)
• 5+ years of experience working with IT developers/programmers in a payer environment
• 5+ years of medical coding experience in a payer environment
• 3+ years of clinical experience in a healthcare environment with strong assessment and critical thinking skills
• Strong knowledge of ICD, CPT, and HCPCS coding methodologies and translation (5+ years)
• Experience managing multiple work efforts simultaneously
• Strong time management skills
• Ability to write and understand business and functional requirements
• Experience with Medicaid policy, coding changes, and system implementation outcomes
• Strong collaboration and relationship-building skills
• Excellent written and verbal communication skills
• Strong knowledge of formal business process documentation

Preferred Qualifications

• 5+ years of experience in policy remediation
• 5+ years of experience with medical claim processing systems
• Knowledge of Microsoft Office (Word, Excel, PowerPoint) and medical coding software such as Optum Encoder

#LI-Remote #LI-PS4 #NowHiring