Job Description :
Clinical Analyst is responsible for analyzing and documenting medical and reimbursement policies; business processes; reports; and fraud and abuse strategies to identify dependencies or logical alignments, and recommending appropriate code changes. The consultant may also author these changes or review the work of others.
The consultant will work with Project Manager, members of the legacy Medicaid Management Information System (MMIS) and Medicaid Eligibility Determination System (MEDS) teams, as well as the Replacement MMIS team. Additionally, the consultant will engage agency executives, business users, actuaries, and clinical staff to identify and perform necessary activities required for project implementation.
The consultant will document plans, findings, and recommendations in writing and via oral presentations and will ensure that all deliverables are completed with high quality and in a timely fashion.
Other duties as assigned.


Clinical Analyst role has three major attributes: clinical knowledge, people skills, and domain knowledge in healthcare insurance and healthcare coding and translation. Candidates must display excellence in all areas.

Clinical experience as a registered nurse or nurse practitioner.
Knowledge and experience in healthcare insurance payment methodologies.
Knowledge of and experience using common coding schemes, particularly ICD, but also including CPT, DRG, HCPCS, etc.
Understanding of IT development and implementation projects.
Vendor management experience.
Superb written and oral communications skills, including the ability to give presentations to executive management. Strong proficiency in English is required
Impeccable integrity. This project will have very high visibility and will impact significant expenditures of public funds. Candidates must be confident with their abilities to make correct decisions and the courage to speak out when necessary.
Willingness and ability to effectively engage with people and organizations on a continuous basis.


Medical coding experience is a significant plus.
Experience with an insurance payer (Medicaid or Medicare preferred) would be a plus.