Location: Columbia, SC
Duration: 12 months
Positions: 1PROJECT:
The ICD-10 Planning Project will prepare the client to migrate to a major
new revision of international medical coding standards. The project will
include evaluating and updating medical policies; updating reimbursement
methodologies; identifying required system changes; updating fraud and abuse
detection and prevention strategies; building an implementation plan and
estimating implementation costs; and providing training and outreach for
agency personnel and Medicaid providers.RESPONSIBILITIES:
The ICD-10 Nurse Analyst is responsible for analyzing and documenting
medical and reimbursement policies; business processes; reports; and fraud
and abuse strategies to identify dependencies or logical alignments with
ICD-9 and recommending changes. The consultant may also author these changes
or review the work of others.
The consultant will work with the ICD-10 Project Manager, members of the
legacy Medicaid Management Information System (MMIS) and Medicaid
Eligibility Determination System (MEDS) teams, as well as the Replacement
MMIS team. Additionally, the consultant will engage agency executives,
business users, actuaries, and clinical staff to identify and perform
necessary activities required to plan for ICD-10 implementation.
As a clinical expert, the consultant will provide advice on ICD-10 in
general, and on strategies with migrating from ICD-9 to ICD-10. The
consultant will document plans, findings, and recommendations in writing and
via oral presentations and will ensure that all deliverables are completed
with high quality and in a timely fashion.
The consultant may oversee the work of vendors involved in ICD-10
activities.
Other duties as assigned. REQUIRED SKILLS (IN ORDER OF IMPORTANCE):
The ICD-10 Nurse Analyst role has three major attributes: clinical
knowledge, people skills, and domain knowledge in healthcare insurance and
ICD-10. Candidates must display excellence in all areas. . Clinical experience as a registered nurse or nurse practitioner.
. Knowledge and experience in healthcare insurance payment
methodologies.
. Knowledge of and experience using common coding schemes,
particularly ICD-9, but also including CPT, DRG, HCPCS, etc.
. Understanding of IT development and implementation projects.
. Vendor management experience.
. Superb written and oral communications skills, including the ability
to give presentations to executive management. Strong proficiency in English
is required.
. Impeccable integrity. This project will have very high visibility
and will impact significant expenditures of public funds. Candidates must be
confident with their abilities to make correct decisions and the courage to
speak out when necessary.
. Willingness and ability to effectively engage with people and
organizations on a continuous basis.
. Candidates will be required to give a PowerPoint presentation on a
topic relevant to the position. The topic will be provided at the time the
interview is scheduled, at least two days in advance.PREFERRED SKILLS (IN ORDER OF IMPORTANCE):
. Medical coding experience is a significant plus.
. Training/experience in ICD-10.
. Experience with an insurance payer (Medicaid or Medicare preferred)
would be a plus.REQUIRED EDUCATION:
Bachelors degree in nursing is required. MSN or MBA would be a plus.REQUIRED CERTIFICATIONS:
Current nursing licensure in any state. Medical coding certification would
be a significant plus.
Duration: 12 months
Positions: 1PROJECT:
The ICD-10 Planning Project will prepare the client to migrate to a major
new revision of international medical coding standards. The project will
include evaluating and updating medical policies; updating reimbursement
methodologies; identifying required system changes; updating fraud and abuse
detection and prevention strategies; building an implementation plan and
estimating implementation costs; and providing training and outreach for
agency personnel and Medicaid providers.RESPONSIBILITIES:
The ICD-10 Nurse Analyst is responsible for analyzing and documenting
medical and reimbursement policies; business processes; reports; and fraud
and abuse strategies to identify dependencies or logical alignments with
ICD-9 and recommending changes. The consultant may also author these changes
or review the work of others.
The consultant will work with the ICD-10 Project Manager, members of the
legacy Medicaid Management Information System (MMIS) and Medicaid
Eligibility Determination System (MEDS) teams, as well as the Replacement
MMIS team. Additionally, the consultant will engage agency executives,
business users, actuaries, and clinical staff to identify and perform
necessary activities required to plan for ICD-10 implementation.
As a clinical expert, the consultant will provide advice on ICD-10 in
general, and on strategies with migrating from ICD-9 to ICD-10. The
consultant will document plans, findings, and recommendations in writing and
via oral presentations and will ensure that all deliverables are completed
with high quality and in a timely fashion.
The consultant may oversee the work of vendors involved in ICD-10
activities.
Other duties as assigned. REQUIRED SKILLS (IN ORDER OF IMPORTANCE):
The ICD-10 Nurse Analyst role has three major attributes: clinical
knowledge, people skills, and domain knowledge in healthcare insurance and
ICD-10. Candidates must display excellence in all areas. . Clinical experience as a registered nurse or nurse practitioner.
. Knowledge and experience in healthcare insurance payment
methodologies.
. Knowledge of and experience using common coding schemes,
particularly ICD-9, but also including CPT, DRG, HCPCS, etc.
. Understanding of IT development and implementation projects.
. Vendor management experience.
. Superb written and oral communications skills, including the ability
to give presentations to executive management. Strong proficiency in English
is required.
. Impeccable integrity. This project will have very high visibility
and will impact significant expenditures of public funds. Candidates must be
confident with their abilities to make correct decisions and the courage to
speak out when necessary.
. Willingness and ability to effectively engage with people and
organizations on a continuous basis.
. Candidates will be required to give a PowerPoint presentation on a
topic relevant to the position. The topic will be provided at the time the
interview is scheduled, at least two days in advance.PREFERRED SKILLS (IN ORDER OF IMPORTANCE):
. Medical coding experience is a significant plus.
. Training/experience in ICD-10.
. Experience with an insurance payer (Medicaid or Medicare preferred)
would be a plus.REQUIRED EDUCATION:
Bachelors degree in nursing is required. MSN or MBA would be a plus.REQUIRED CERTIFICATIONS:
Current nursing licensure in any state. Medical coding certification would
be a significant plus.
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