Long-Term Care; LTC Medical Coding Policy SME - Remote, Wisconsin

Long-Term Care (LTC) Medical Coding Policy SME - Remote, Wisconsin

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 work groups 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…