Direct-Senior Healthcare Coding & Clinical Program Integrity Analyst(Remote)
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Roman CII Diversities
May 6, 2026, 9:29:33 AM (7 days ago) May 6
to Comspark group Recruiter
Comspark Group a global, innovation-driven technology firm operating across the USA, India, Canada, Saudi Arabia, UAE, and Egypt, with over 18 years of leadership in resource outsourcing and specialized in advanced technologies currently seeking senior, qualified professionals for the following role with one of our direct clients.
Job Title: Senior Healthcare Coding & Clinical Program Integrity Analyst(Remote)
Location: Columbia, South Carolina.
Contract: 12+ Months
Only Local to South Carolina Candidates, Must submit Local DL OR any alternate resident proof.
Need State/public sector Experience
Specific duties include, but are not limited to:
• Collaborates with internal recipient and owner of initial review of codes to determine scope of changes for planning and timely completion.
• Receives listings of codes changes distributed to the Reference Administration and Medicaid Program staff for review and analysis.
• Serves as an approver within the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
• Serves as lead for meetings with Agency personnel, stakeholders, and process owners.
• Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
• Researches business rules, requirements, and models to complete initial analysis and recommendations.
• Maintains business rules, requirements, and models in a repository.
• Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
• Participates in agency projects and related initiatives requiring subject matter expertise.
• Other duties, as assigned or required.
• Collaborates with internal recipient and owner of initial review of codes to determine scope of changes for planning and timely completion.
• Receives listings of codes changes distributed to the Reference Administration and Medicaid Program staff for review and analysis.
• Serves as an approver within the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
• Serves as lead for meetings with Agency personnel, stakeholders, and process owners.
• Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
• Researches business rules, requirements, and models to complete initial analysis and recommendations.
• Maintains business rules, requirements, and models in a repository.
• Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
• Participates in agency projects and related initiatives requiring subject matter expertise.
• Other duties, as assigned or required.
REQUIRED SKILLS:
• 5 years’ experience in healthcare insurance; medical review, program integrity, or appeals.
• 5 years’ experience working with IT developers/programmers in a payor environment.
• 5 years’ experience Medical Coding in payer environment.
• 3 years’ clinical experience in a healthcare environment (Strong clinical assessment and critical thinking skills.)
• 5 years’ strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
• 5 years’ experience working with IT developers/programmers in a payor environment.
• 5 years’ experience Medical Coding in payer environment.
• 3 years’ clinical experience in a healthcare environment (Strong clinical assessment and critical thinking skills.)
• 5 years’ strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
PREFERRED SKILLS:
• 5 years’ experience in policy remediation.
• 5 years’ Medical Claim processing systems experience.
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs).
• Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs).
*Celebrating 19th year Anniversary*
Thanks & Regards,ROMAN BOSE
Director-(Projects & Staffing)
ro...@ciidiversities.com
CII DIVERSITIES LLC(Subsidiary of Comspark group)
Minority Certified | ISO 9001-2008 Certified/ SAP/Dell boomi Partners
Outsourcing | Digital I Cyber| Development | ERP I Data/AII Staffing
www.ciidiversities.com
USA | INDIA | EGYPT|KSA|UAE I CANADA
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