IT Healthcare Consultant – Business Analyst (Clinical Analyst & Coding Specialist) - BA 26-05744

Job Title: IT Healthcare Consultant – Business Analyst (Clinical Analyst & Coding Specialist)
Location: Fully Remote
Job Type: Contract (12 Months)

Job Overview: We are seeking an experienced IT Healthcare Consultant / Business Analyst with strong expertise in clinical analysis and medical coding. This role will focus on maintaining and updating coding systems, supporting Medicaid-related processes, and collaborating with stakeholders to ensure compliance and operational efficiency.

Key Responsibilities:

• Manage and implement ICD-10, CPT, and HCPCS code updates (annual and quarterly)
• Review and analyze coding changes to determine business impact
• Prepare and present code change documentation for stakeholders
• Conduct meetings with internal teams, stakeholders, and process owners
• Act as Subject Matter Expert (SME) for medical coding and healthcare policies
• Research and document business rules, requirements, and models
• Maintain documentation repositories and ensure process updates
• Support training content development and updates
• Assist with medical necessity reviews when required
• Participate in system/project meetings related to healthcare systems

Required Qualifications:

• 5+ years of experience in healthcare insurance (medical review, program integrity, or appeals)
• 5+ years of experience working with IT teams in a payer environment
• 5+ years of medical coding experience in a payer environment
• 3+ years of clinical healthcare experience
• Strong knowledge of ICD, CPT, and HCPCS coding methodologies
• Strong understanding of anatomy, physiology, pharmacology, and medical terminology
• Excellent written and verbal communication skills
• Proficiency in Microsoft Office Suite

Preferred Qualifications:

• Experience in policy remediation
• Experience with claims processing systems
• Experience with coding tools such as Optum Encoder or similar

Education Requirements:

• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)

Certifications Required:

• Active, unrestricted Registered Nurse (RN) license
• CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification
• ICD-10 certification (or ability to obtain within 1 year)

For more details reach at resumes@navitassols.com.