MMIS Reference Administrator
Full Time • Fully Remote - US
Benefits:
- Competitive salary
Location
Fully Remote
Candidate must be a South Carolina resident
Must work Eastern Time Zone hours
Fully Remote
Candidate must be a South Carolina resident
Must work Eastern Time Zone hours
Experience Level
Mid–Senior Level (5 or more years of relevant experience)
Mid–Senior Level (5 or more years of relevant experience)
Role Overview
The MMIS Business Analyst and Medical Coding Specialist provides subject matter expertise supporting Medicaid Management Information System operations and change initiatives. This role focuses on medical coding maintenance, claims adjudication outcomes, and alignment of system updates with Medicaid policy and federal requirements. The position works closely with policy staff, IT developers, and stakeholders to ensure accurate implementation of coding changes and high-quality service delivery.
The MMIS Business Analyst and Medical Coding Specialist provides subject matter expertise supporting Medicaid Management Information System operations and change initiatives. This role focuses on medical coding maintenance, claims adjudication outcomes, and alignment of system updates with Medicaid policy and federal requirements. The position works closely with policy staff, IT developers, and stakeholders to ensure accurate implementation of coding changes and high-quality service delivery.
Key Responsibilities
MMIS Analysis & Support
- Investigate, analyze, and resolve complex MMIS-related issues
- Maintain deep knowledge of MMIS procedure codes, pricing logic, and claims processing workflows
- Ensure system updates and change requests result in expected adjudication outcomes for members and providers
- Supervise staff supporting MMIS updates and reference administration activities
Medical Coding & Policy Alignment
- Support CPT, HCPCS, and ICD-10 code maintenance activities
- Review and analyze annual, quarterly, and ad hoc coding updates from CMS
- Serve as an approver within the code change and update lifecycle
- Ensure alignment between medical coding changes, Medicaid policy, and system functionality
Business Requirements & Documentation
- Research and document business rules, functional requirements, and process models
- Maintain business rules and requirements repositories
- Ensure process documentation and training materials remain accurate and up to date
- Translate complex technical and policy concepts for both technical and non-technical audiences
Stakeholder Collaboration & Leadership
- Serve as a subject matter expert for medical coding methodologies and Medicaid policy
- Lead meetings with stakeholders, process owners, and agency staff
- Facilitate collaboration between business, policy, and IT teams
- Participate in agency initiatives requiring coding and MMIS expertise
Project Support & Continuous Improvement
- Support multiple concurrent initiatives with strong time management and prioritization
- Analyze, plan, execute, and evaluate agency priorities and initiatives
- Promote high customer service standards across stakeholder engagements
- Perform additional duties as assigned
Required Qualifications
- Bachelor’s degree in Health Information, Healthcare Administration, or related field, or equivalent professional experience
- 5 or more years of experience in healthcare insurance, medical review, program integrity, or appeals
- 5 or more years of experience working with IT developers or programmers in a payer environment
- 5 or more years of experience performing medical coding in a payer environment
- 5 or more years of experience translating ICD, CPT, and HCPCS coding methodologies
- 3 or more years of clinical experience in a healthcare environment
- Strong experience supporting medical claims processing systems
- Ability to write and interpret business and functional requirements
- Proficiency with Microsoft Word, Excel, and PowerPoint
Preferred Qualifications
- 5 or more years of experience supporting policy remediation initiatives
- Experience with Optum Encoder or similar medical coding software
- Experience supporting government operations or managed care environments
Core Skills & Attributes
- Strong analytical and problem-solving skills
- Excellent written, verbal, and interpersonal communication abilities
- Ability to communicate effectively with executive leadership, project teams, and technical staff
- Strong collaboration and relationship-building skills
- High attention to detail and accuracy
- Ability to manage multiple work efforts simultaneously
This is a remote position.
Established in 2004, Smart Tech Skills is a top technology and professional services firm specializing in innovative technologies.
Headquartered in Marlborough, MA, the company effectively addresses clients’ technology needs nationwide, making advanced technology management easier.
Headquartered in Marlborough, MA, the company effectively addresses clients’ technology needs nationwide, making advanced technology management easier.
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