Clinical Systems Analyst (Healthcare)

TL;DR

Clinical Systems Analyst (Healthcare): Managing medical code change requests and system enhancements for healthcare insurance platforms with an accent on ICD-10/CPT/HCPCS methodologies and clinical policy alignment. Focus on bridging the gap between clinical requirements and IT implementation through expert analysis and stakeholder collaboration.

Location: Hybrid role based in Columbia, SC with flexible work from home options available.

Company

hirify.global is a technology and professional services firm established in 2004, specializing in innovative technology management solutions.

What you will do

• Manage annual and quarterly CMS updates for ICD-10 and CPT/HCPCS coding changes.
• Perform initial reviews of code modifications to determine operational and system impacts.
• Serve as the primary Subject Matter Expert for medical coding methodologies and healthcare policies.
• Collaborate with IT developers to translate clinical needs into technical requirements and data models.
• Facilitate meetings with cross-functional stakeholders and process owners.
• Review patient records against established criteria to determine medical necessity.

Requirements

• Education: BSN or ADN degree required.
• Licensure: Current, active, and unrestricted RN license in the State of South Carolina.
• Certification: Active CPC or CCS credential required.
• Experience: 10+ years in healthcare insurance, 5+ years in medical coding, and 5+ years working with IT developers in a payer environment.
• Knowledge: Deep foundational knowledge in coding methodologies, anatomy, physiology, and pharmacology.

Nice to have

• 5+ years of experience in policy remediation.
• Experience with healthcare claims processing systems.
• Proficiency with Optum Encoder or similar medical coding software.

Culture & Benefits

• Flexible work from home options.
• Opportunity to work in a change-oriented, fast-paced project environment.
• Engagement with large-scale enterprise system replacement initiatives.