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.

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 throughAugust 10, 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 also have a variety of leadership and technical development academies to help build your skills and capabilities.

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.

About Gainwell Technologies

For 50 years, our nation’s federal Medicaid program has worked to improve the health, safety and well-being of America’s most vulnerable populations: low-income families, women and children, seniors, and those with disabilities. With positive health and cost outcomes that pierce inequities and impact economies, the success of these programs is inextricably tied to the prosperity of communities, individual states and the nation as a whole. We think that demands respect and, more importantly, is deserving of a lifetime commitment from innovators who can help those who operate within and around health and human services evolve — in any market at any stage. At Gainwell Technologies, that’s our sole focus.

Built across more than five decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet agencies, health plans and MCOs where they are on their modernization journeys and propel them into the future of public health. Our commitment to innovation, deep experience and ability to leverage insights from customers across 50 states has allowed us to expand on next-generation, cloud-enabled technologies.

Today, Gainwell offers one of the most comprehensive suites of scalable services and solutions on the market — all proven to deliver cost savings, better patient outcomes and an improved provider experience. Equally important to our expanding technologies and results: We bring ideas that bring policies to life.

Industry

IT & Software

Company Size

10,000+ employees

Headquarters

United States

Year Founded

Unknown

Website

gainwelltechnologies.com

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