Medical Coding Policy SME

🕒 5 days ago

🇺🇸 United States – Remote

💵 $64.5k - $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Review annual and quarterly CPT, HCPCS, and ICD-10 code set updates for impacts on Long-Term Care waiver programs, State Plan services, and Medicaid operations • Serve as medical coding SME for Long-Term Care coding workgroups and MMIS project initiatives • Support policy implementation, systems configuration, provider enrollment, encounter reporting, and reimbursement processes • Research and respond to complex medical coding and policy inquiries from contracted providers • Collaborate with cross-functional teams to ensure accurate and consistent coding and policy guidance • Lead meetings and facilitate stakeholder discussions • Develop agendas, document meeting minutes, track action items, and drive projects to completion • Maintain and enhance documentation of coding policies, reimbursement methodologies, coverage decisions, and coding guidance • Collaborate with state agencies, business partners, MMIS teams, provider enrollment teams, and healthcare policy stakeholders • Participate in cross-functional projects involving coding policy, systems implementation, provider operations, and reimbursement methodologies

🎯 Requirements

• Experience with CPT, HCPCS Level II, ICD-10, medical coding, reimbursement policy, claims processing, provider enrollment, healthcare operations, or Medicaid programs • Preferred certifications include CPC, COC, CCS, RHIA, or RHIT • Strong critical thinking, analytical, and problem-solving skills • Ability to interpret regulatory guidance, assess operational impacts, and develop recommendations • Project management experience, including planning, coordinating, driving cross-functional initiatives, managing timelines, tracking deliverables, and ensuring project completion • Experience leading meetings, coordinating stakeholders, drafting agendas, documenting meeting minutes, and tracking project deliverables • Excellent written and verbal communication skills • Ability to present recommendations, facilitate discussions, and develop formal documentation • Proficiency with Microsoft Office applications, including Excel, Word, PowerPoint, Teams, and SharePoint • Strong organization, prioritization, project management, and stakeholder engagement skills • Ability to pick up assigned equipment in Madison, WI, if selected • Wisconsin residency preferred but not required

🏖️ Benefits

• Work flexibility • Learning and career development • Generous, flexible vacation policy • Educational assistance • Leadership and technical development academies • 401(k) employer match • Comprehensive health benefits • Limited travel (0–10%) • Assigned equipment provided for remote work