Medical Coding Policy SME - Remote Wisconsin

Gainwell Technologies; Wisconsin; On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Flexible vacation policy

Educational assistance

Leadership and technical development**

Job summary

Gainwell Technologies seeks a Long-Term Care Medical Coding Policy SME to support Wisconsin Medicaid LTC programs through medical coding analysis, policy implementation, and MMIS collaboration. You will review CPT, HCPCS, and ICD-10 updates, respond to policy inquiries, and work with providers and stakeholders to ensure compliant guidance and reimbursement policies.

The role requires strong coding expertise, project management, and ability to lead cross-functional initiatives in a

Qualifications

• Experience with CPT, HCPCS Level II, ICD-10 coding and reimbursement policy.
• Strong written and verbal communication for policy interpretation.

Responsibilities

• Review CPT, HCPCS Level II, and ICD-10 code set updates and assess impacts on waiver programs and Medicaid processes.
• Serve as medical coding SME for LTC coding workgroups and MMIS projects.
• Research and respond to complex coding and policy inquiries with cross-functional teams.
• Lead meetings, facilitate stakeholder discussions, and document actions and decisions.
• Maintain and enhance coding policy documentation and guidance.

Skills

CPT/HCPCS/ICD-10 knowledge

Medical coding expertise

Reimbursement policy understanding

Claims processing knowledge

Provider enrollment experience

Healthcare operations

Medicaid programs familiarity

Education

CPC/COC/CCS/RHIA/RHIT certifications

Tools

Microsoft Office (Excel, Word, PowerPoint, Teams, SharePoint)

Job 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.

Summary

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, and 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.

Your role in our mission

• Review annual and quarterly CPT, HCPCS, and ICD-10 code set updates to evaluate impacts on Long-Term Care waiver programs, State Plan services, and Medicaid operational processes.
• Serve as the medical coding subject matter expert for Long-Term Care coding workgroups and MMIS project initiatives, supporting policy implementation, systems configuration, provider enrollment, encounter reporting, and reimbursement processes.
• Research and respond to complex medical coding and policy inquiries from contracted providers, collaborating with cross-functional teams to ensure accurate and consistent guidance.
• Lead meetings, 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 to establish a centralized source of truth for internal and external stakeholders.

What We're Looking For

• 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 with the ability to interpret regulatory guidance, assess operational impacts, and develop recommendations.
• Project management experience, including planning, coordinating, and driving cross-functional initiatives, managing timelines, tracking deliverables, and ensuring successful project completion.
• Experience leading meetings, coordinating stakeholders, drafting agendas, documenting meeting minutes, and tracking project deliverables.
• Excellent written and verbal communication skills with the ability to present recommendations, facilitate discussions, and develop formal documentation.
• Proficiency with Microsoft Office applications, including Excel, Word, PowerPoint, Teams, and SharePoint, with experience managing documentation and project-related materials.

What You Should Expect In This Role

• Opportunity to support Wisconsin Medicaid Long-Term Care programs and contribute to policy, coding, reimbursement, and operational initiatives that impact healthcare providers and members.
• 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.

Location and travel requirements

• This role is eligible for remote work anywhere in the United States.
• Primary office location: Madison, WI.
• Wisconsin residency is preferred but not required.
• Limited travel required (0–10%).
• Candidates must be able to pick up assigned equipment in Madison, WI, if selected for this position.

Applications for this position will be accepted through October 6, 2026.

The pay range for this position is $64,500.00 - $85,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development.

All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.