Coding Policy Specialist
4 weeks ago
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 MissionAs 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.
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.
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.
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