Coding Policy Specialist

4 weeks ago


Texas City, Texas, United States Gainwell Technologies Full time

Gainwell Technologies is seeking a skilled Coding Policy Specialist to join our team. As a key member of our organization, you will play a vital role in developing and documenting clinical and coding content standards. Your expertise will help us harness the power of technology to improve the health and well-being of our clients' members.

Your Role in Our Mission

As a Coding Policy Specialist, you will work closely with our Medical Director and Innovation teams to identify best practices in the company or industry and apply them to solution development. You will also monitor and research changes in coding guidelines, determining their impact on our programs.

  • Develop clinical and coding content that drives decision-making and documentation for our Clinical Services, Quality, and Appeals teams.
  • Collaborate with clinical teams to ensure that coding content standards are well understood by all levels of the organization.
  • Provide primary SME support regarding clinical policy, clinical review programs, and processes to account management and sales teams for both State and Health plan clients.
  • Meet with clients to explain programs and processes, discuss concerns, identify issues, and develop proactive solutions to problems they may be having or anticipate having with our clinical and coding review programs.
What We're Looking For

We are seeking a highly experienced professional with a strong background in ICD 10 CM/PCS, MS-DRG, APR DRG claims, and encoder products. In addition, experience with APC and EAPG is preferred. You must have inpatient coding certification (CCS, CIC, RHIA, RHIT) and the ability to research State and Federal regulations, clinical policies, and coding guidelines to develop and implement policies, clinical/coding resources, and tools to support our Clinical Claim Review products.

  • 10+ years of experience reviewing and auditing ICD 10 CM/PCS, MS-DRG, APR DRG claims and proficiency with encoder products.
  • Ability to independently perform research and analysis leveraging claims data to develop new audit strategies, solutions, edits, and targets.
  • Deep experience with the principles of inpatient and outpatient billing and coding audits, with the ability to provide Subject Matter Expert (SME) level support to our clinical organization.
What You Can Expect in This Role

As a Coding Policy Specialist at Gainwell Technologies, you can expect a fully remote opportunity with a competitive salary range of $69,400.00 - $99,200.00 per year. You will also be eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We offer a variety of leadership and technical development academies to help build your skills and capabilities.

We believe that nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell Technologies, an industry leader, and join a company where collaboration, innovation, and inclusion fuel our growth.



  • Texas City, Texas, United States Omni Inclusive Full time

    Job SummaryWe are seeking a highly skilled and customer-focused Technical Support Specialist to join our End User Support team at Omni Inclusive. As a key member of our team, you will provide timely and high-quality technical support to our customers, ensuring their technical issues are resolved efficiently and effectively.Key ResponsibilitiesProvide...


  • Texas City, Texas, United States City of Midland, TX Full time

    Job SummaryWe are seeking a highly skilled Electrical Systems Specialist to join our team at the City of Midland, TX. As an Electrical Systems Specialist, you will be responsible for troubleshooting and maintaining electrical, SCADA, and control equipment throughout the Utilities Department.Key ResponsibilitiesTroubleshoot and repair electrical service to...


  • Texas City, Texas, United States Galveston County Health District Full time

    Job Title: CHW Revenue Cycle Management Billing SpecialistGalveston County Health District is seeking a highly skilled Revenue Cycle Management Billing Specialist to join our team. As a key contributor to our revenue cycle performance, you will be responsible for ensuring accurate and timely billing and reimbursement for our medical, dental, and behavioral...

  • Packaging Specialist

    3 weeks ago


    Texas City, Texas, United States Cenergy International Full time

    Packaging Specialist Job DescriptionThe Packaging Specialist is responsible for ensuring the efficient and accurate bagging and drum-filling operation at Cenergy International. This role requires attention to detail, strong communication skills, and the ability to work effectively in a team environment.Key Responsibilities:Bagging and Drum-Filling...


  • Texas City, Texas, United States Yoh Full time

    Job Title: Active Directory SpecialistJob Summary:Yoh, a Day & Zimmermann company, is seeking an experienced Active Directory Specialist to join our team. As an Active Directory Specialist, you will be responsible for administering and maintaining Active Directory infrastructure, including user accounts, groups, and organizational units. You will also...


  • Texas City, Texas, United States CenterWell Senior Primary Care Full time

    Job Summary:CenterWell Senior Primary Care is seeking a skilled and compassionate Primary Care Physician to join our team. As a Family Medicine Specialist, you will be responsible for evaluating and treating patients in accordance with standards of care.Key Responsibilities:Evaluates and treats patients in accordance with standards of care.Follows level of...

  • Nurse Specialist

    4 weeks ago


    Texas City, Texas, United States Houston Independent School District Full time

    Job SummaryAs a Nurse Specialist with the Houston Independent School District, you will play a vital role in implementing health programs, providing health counseling, and offering preventive health services to students, parents, and staff. This is an exciting opportunity to make a positive impact on the health and well-being of our community.Key...


  • Texas City, Texas, United States PSG Global Solutions Careers Full time

    Job Title: Hedis Coder/AbstractorWe are seeking a highly skilled Hedis Coder/Abstractor to join our team at PSG Global Solutions Careers. As a Hedis Coder/Abstractor, you will play a critical role in reviewing medical records and documenting clinical data for Hedis reporting.Key Responsibilities:Review medical records and extract relevant clinical data for...


  • Texas City, Texas, United States PSG Global Solutions Careers Full time

    Job Title: Hedis Coder/AbstractorWe are seeking a highly skilled Hedis Coder/Abstractor to join our team at PSG Global Solutions Careers. As a Hedis Coder/Abstractor, you will be responsible for reviewing medical records and documenting clinical data for Hedis reporting.Key Responsibilities:Review medical records and extract relevant details and data for...

  • Nurse Specialist

    4 weeks ago


    Texas City, Texas, United States Houston Independent School District Full time

    Job SummaryWe are seeking a skilled Nurse Specialist to join our team at the Houston Independent School District. The successful candidate will be responsible for implementing health programs, providing health counseling, and delivering preventive health services to students, parents, and staff.Key ResponsibilitiesDevelop and implement health care plans and...


  • Texas City, Texas, United States Houston Independent School District Full time

    Job Title: Nurse - Early Childhood Health SpecialistLocation: Bellfort Early Childhood CenterDepartment: Bellfort ECCArea: SouthContract Months: 10Hourly Rate: $61,500.00Job Summary:The Houston Independent School District is seeking a highly skilled and dedicated Nurse - Early Childhood Health Specialist to join our team. As a key member of our school health...


  • Texas City, Texas, United States Bexar County, TX Full time

    Job SummaryWe are seeking a highly skilled Absence and Leave Specialist to join our team at Bexar County, TX. As a key member of our Human Resources department, you will be responsible for evaluating, responding, and instructing on all leave of absence programs, including family and medical leave, paid parental leave, military leave, and paid time off.Key...


  • Texas City, Texas, United States Galveston County Health District Full time

    Job DescriptionGalveston County Health District is seeking an Animal Control Officer to join our team of professionals. This position is responsible for enforcing ordinances and statutes related to the control of dogs and cats by patrolling assigned areas and picking up animals in violation of state and/or county codes.Key Responsibilities:Enforces...


  • Texas City, Texas, United States CEVA Full time

    Job SummaryCEVA Logistics is seeking a highly skilled and motivated Warehouse Operations Specialist to join our team. As a key member of our operations team, you will be responsible for executing essential operational processes and contributing to delivering results in a safe and efficient warehouse environment.Key ResponsibilitiesDevelop and provide...


  • Texas City, Texas, United States Galveston County Health District Full time

    Job SummaryWe are seeking a highly skilled and dedicated Dental Care Specialist to join our team at the Galveston County Health District. As a key member of our dental team, you will be responsible for providing high-quality dental care to our patients, including routine cleanings, fillings, and extractions.Key Responsibilities:Perform direct dental care to...


  • Texas City, Texas, United States Galveston County Health District Full time

    Job Title: Disease Intervention SpecialistWe are seeking a highly skilled and dedicated Disease Intervention Specialist to join our team at the Galveston County Health District. As a key member of our team, you will play a critical role in safeguarding the citizens of Galveston, Brazoria, and Chambers from sexually transmitted diseases (including AIDS) by...


  • Texas City, Texas, United States Bexar County, TX Full time

    Job SummaryWe are seeking a highly skilled Absence and Leave Specialist to join our team at Bexar County, TX. The successful candidate will be responsible for evaluating, responding, and instructing on all leave of absence programs, including family and medical leave, paid parental leave, military leave, and paid time off.Key ResponsibilitiesDevelop,...


  • Texas City, Texas, United States College of the Mainland Full time

    Job SummaryWe are seeking a highly skilled and detail-oriented Student Records Specialist to join our team at College of the Mainland. As a key member of our Admissions and Records Office, you will be responsible for performing complex technical and specialized office support work, including data entry, record management, and customer service.Key...

  • Medical Assistant

    3 weeks ago


    Texas City, Texas, United States Galveston County Health District Full time

    Job OverviewWe are seeking a skilled Medical Assistant to join our team at the Galveston County Health District. As a Medical Assistant, you will play a vital role in providing high-quality patient care and supporting our healthcare professionals.Key ResponsibilitiesPrepare patients for exams and procedures, ensuring accurate documentation in the electronic...


  • Texas City, Texas, United States OrthoLoneStar PLLC Full time

    Job Title: Patient Refund SpecialistThe Patient Refund Specialist plays a vital role in ensuring seamless patient experiences at OrthoLoneStar clinics. Key responsibilities include:Providing exceptional customer service by answering incoming calls and addressing patient inquiriesReviewing patient accounts to identify refund opportunities and processing...