South Carolina Licensed IT Healthcare Consultant

Job Summary

Working 100% remotely, the part-time South Carolina Licensed IT Healthcare Consultant will leverage clinical and coding expertise to drive Medicaid and CMS coding initiatives, collaborating with agency stakeholders and leading code maintenance in a 12-month contract role.

Key responsibilities

• Lead annual and quarterly updates and maintenance of ICD-10, CPT, and HCPCS codes from CMS
• Review code changes, determine scope, and prepare documentation for Reference Administration and Medicaid Program staff
• Provide subject matter expertise on medical coding methodologies and Medicaid policy

Required qualifications

• 10+ years in healthcare insurance, including medical review, program integrity, or appeals
• 5+ years collaborating with IT teams/programmers in a payer environment
• Active, unrestricted Registered Nurse licensure from the State of South Carolina Board of Nursing
• Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
• Current credential as Certified Professional Coder (CPC) or Certified Coding Specialist (CCS), or ICD-10 proficiency demonstrated by exam