My name is Himanshu , and I serve as the Recruitment Manager at Nexiva INC. I am reaching out to share an excellent career opportunity for the role of "Business Analyst" with our esteemed client. If you are interested then please share your updated resume at Himanshu@nexivainc.com
Job Description
Position : Business Analyst (Medicaid / MMIS)
Location : Remote (Must reside in South Carolina)
Duration : 12 Months (Extendable)
Job Summary
Seeking a Business Analyst Consultant to support Medicaid MMIS operations with a strong focus on medical coding updates, policy alignment, and system enhancements. The role acts as a Subject Matter Expert (SME) for ICD-10, CPT, and HCPCS coding changes and ensures accurate implementation within Medicaid claims systems.
Key Responsibilities
Support Medicaid coding changes (ICD-10, CPT, HCPCS) and system updates
Analyze and validate medical code change requests from CMS and stakeholders
Work with business and IT teams to translate requirements into system updates
Ensure accurate claims processing and policy alignment within MMIS
Serve as SME for Medicaid coding, policy, and claims workflows
Support documentation, requirement gathering, and process improvements
Participate in stakeholder meetings and provide functional guidance
Required Experience
5+ years healthcare insurance experience (payer environment)
5+ years medical coding experience (ICD-10, CPT, HCPCS)
5+ years working with IT/development teams in healthcare systems
3+ years clinical or healthcare operations experience
Strong knowledge of Medicaid policies and claims processing systems
Experience in business requirements and functional documentation
Key Focus
Medicaid coding updates, MMIS system support, policy compliance, and claims accuracy through effective business analysis and stakeholder coordination.
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