Clinical Analyst & Coding Specialist

On-site position; applicants must be local. - Requires BSN or ADN degree. - Must have an active, non-restricted South Carolina RN license. - Must hold current CPC or CCS certification (or obtain within one year); ICD-10 proficiency required. - Minimum 5 years experience in healthcare insurance (medical review, program integrity, or appeals). - At least 5 years working with IT developers/programmers in a payer environment. - At least 5 years experience with medical coding in a payer environment. - Minimum 3 years of direct clinical experience with strong assessment and critical thinking skills. - At least 5 years knowledge of ICD, CPT, HCPCS coding, and related methodologies. - Extensive knowledge (5+ years) of anatomy, physiology, pharmacology, and medical terminology. - Preferred: 5+ years experience in policy remediation. - Preferred: 5+ years experience with claims processing systems. - Preferred: 5+ years experience using Optum Encoder or similar medical coding software.