[Hiring] Long-Term Care Medical Coding Policy SME @Gainwell Technologies LLC

Role Description

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

The Long-Term Care (LTC) Medical Coding Policy SME serves as a subject matter expert supporting Wisconsin Medicaid Long-Term Care programs through medical coding analysis, policy implementation, systems collaboration, and project participation. This role is responsible for:

• Reviewing and evaluating CPT, HCPCS, and ICD-10 coding updates.
• Supporting MMIS-related initiatives.
• Researching complex policy and coding questions.
• Partnering with internal and external stakeholders to ensure coding guidance, system configuration, and reimbursement policies remain accurate and compliant.

The ideal candidate combines healthcare coding expertise with strong critical thinking, project management, communication, and documentation skills.

Qualifications

• Experience working with CPT, HCPCS Level II, ICD-10, medical coding, reimbursement policy, claims processing, provider enrollment, healthcare operations, or Medicaid programs.
• Preferred certifications include Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT).
• Strong critical thinking, analytical, and problem-solving skills.
• Project management experience, including planning, coordinating, and driving cross-functional initiatives.
• Experience leading meetings, coordinating stakeholders, drafting agendas, documenting meeting minutes, and tracking project deliverables.
• Excellent written and verbal communication skills.
• Proficiency with Microsoft Office applications, including Excel, Word, PowerPoint, Teams, and SharePoint.

Requirements

• Opportunity to support Wisconsin Medicaid Long-Term Care programs.
• Collaboration with state agencies, business partners, MMIS teams, provider enrollment teams, and healthcare policy stakeholders.
• Participation in cross-functional projects involving coding policy, systems implementation, provider operations, and reimbursement methodologies.
• Independent remote work environment requiring strong organization, prioritization, project management, and stakeholder engagement skills.
• Professional growth through involvement in healthcare policy development, Medicaid operations, medical coding initiatives, and enterprise-wide projects.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies.