Remote Kettering Health Network Nurse Rn Jobs in Chapin, SC

Required Skills

Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)

Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.

Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.

5+ years in healthcare insurance; medical review, program integrity, or appeals.

5+ years working with IT developers/programmers in a payor environment.

5+ years Medical Coding in payer environment

3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)

5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.

5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.

Preferred Skills

5+ years’ experience in policy remediation.

5+ years claims processing systems experience.

5+ years Optum Encoder and/or other medical coding software programs

Objectives to Be Fulfilled by Candidate:

The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. As the IT Healthcare Consultant – Business Analyst – Advanced (Clinical Analyst and Coding Specialist):

Specific duties include, but are not limited to:

• Initiates annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
• Performs initial review of codes to determine scope of changes.
• Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis.
• Conducts meetings with Agency personnel, stakeholders, and process owners.
• (Future) Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
• Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
• Research business rules, requirements, and models to complete initial analysis and recommendations.
• Maintains business rules, requirements, and models in a repository.
• Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
• May serve as a back-up to review patient records against established criteria to determine medical necessity.
• Other project-related duties.
• 5+ years written and oral communications skills, strong proficiency in English.
• Knowledge of Microsoft Office Suite

Required Skills (rank in order of Importance):

• 5+ years in healthcare insurance; medical review, program integrity, or appeals.
• 5+ years working with IT developers/programmers in a payor environment.
• 5+ years Medical Coding in payer environment.
• 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
• 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
• 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.

Preferred Skills (rank in order of Importance):

• 5+ years’ experience in policy remediation.

• 5+ years claims processing systems experience.
• 5+ years Optum Encoder and/or other medical coding software programs

Required Education:

Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)

Required Certifications:

Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.

Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.

Donato Technologies Inc. is a trusted IT staffing, consulting, and software development partner headquartered in Dallas, Texas. We support clients across industries by understanding their unique business needs and delivering tailored technology and workforce solutions. Our focus is on connecting the right talent with the right opportunity-ensuring clients receive dependable, skilled professionals and candidates receive meaningful career growth and support. We work closely with small to mid-sized organizations to provide flexible, high-quality services that drive performance, innovation, and long-term success.