[Hiring] Business Analyst @Nexiva

Role Description

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

Qualifications

• 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.