Business Analyst with Deep SME in ICD-10 and ICD Code Set Mapping
Duration: 6 months
Washington, DC
EAD/GC/CITIZENS ONLY!!
We are currently recruiting for a Business and Requirements Analyst who is a subject matter expert in ICD 10 Code Set Mapping and in understanding how these changes effect policy, business processes, and claims. This position is much more than minor translation of how some ICD 9 codes may change in ICD 10. It impacts how a wide variety claims will be processed and paid and requires in depth knowledge of both ICD 10 code mapping and how it impacts benefits.
Background:
This position is expected to work as part of the Business Solutions Team supporting our client's ICD-10 team.
Required Skills and Experience:
• Candidate must demonstrate complete knowledge of the ICD-9 Code Set structure.
• Candidate must demonstrate complete knowledge of the ICD-9 Body Systems.
• Candidate must demonstrate complete of the ICD-10-CM Code Set structure.
• Candidate must demonstrate deep knowledge of all ICD-10-CM Body Systems.
• Candidate must demonstrate ability to translate clinical concepts to commonly understood business challenges
• Candidate must have solid understanding of the ICD-9 and ICD-10 Coding and Reimbursement manuals
• Candidates demonstrate the ability to code the Index to the Tabular list of Diseases and Injuries in the coding manuals.
• Candidate must be able to demonstrate ability to contrast and relate the differences between the ICD-9 and ICD-10 code set
• Candidate must demonstrate knowledge mapping ICD-9-CM codes to ICD-10-CM codes and ICD-10-CM to ICD-9-CM Diagnosis Codes
• Candidate must be able to demonstrate experience and knowledge using General Equivalence Mapping (GEMs)
• Candidate must be able to demonstrate experience and knowledge using CMS Reimbursement Mapping
• Candidate must be able to demonstrate experience in creating Native ICD Code Set Maps
• Candidate must be able to demonstrate experience and knowledge of Healthcare Benefit Administration in correlation with the ICD Code Set
• Candidate must understand how Diagnosis Codes impact benefit assignment and determination.
• Candidate must have a solid understanding and experience in claim adjudication and editing systems
• Candidate must have strong communication, writing and analytical skills
• Candidate must have strong customer skills with internal and external customers
• Candidate must be able to perform assigned tasks with minimum supervision
• Candidate must have experience using multiple requirements elicitation techniques such a facilitating of Joint Application (JAD) sessions
Desired Skills and Experience:
• ICD-10 Code Set to Benefit Administration Code Groups map Knowledge and Experience
• Certifications and/or professional designations are desirable :
o Certified Coding Specialist (CCS)
o Certified Coding Specialist - Physician-based (CCS-P)
o Certified Professional Coder-Hospital Outpatient (CPC-H®)
• Candidate possessing nursing credentials is desirable
A business related writing sample is required.
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(443) 278-8867
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