Medical Coding Policy SME

This is a fully remote position, open to applicants in United States.

📋 Description

• Analyze annual and quarterly updates to CPT, HCPCS, and ICD-10 code sets for their effects on Long-Term Care waiver programs, State Plan services, and Medicaid operations.

• Act as a subject matter expert in medical coding for Long-Term Care coding workgroups and MMIS project initiatives.

• Assist in the implementation of policies, system configurations, provider enrollments, encounter reporting, and reimbursement processes.

• Investigate and address complex medical coding and policy queries from contracted providers.

• Work collaboratively with cross-functional teams to guarantee precise and consistent coding and policy advice.

• Facilitate meetings and lead discussions with stakeholders.

• Prepare meeting agendas, record minutes, monitor action items, and ensure projects reach completion.

• Maintain and improve documentation related to coding policies, reimbursement methods, coverage decisions, and coding guidance.

• Collaborate with state agencies, business partners, MMIS teams, provider enrollment teams, and healthcare policy stakeholders.

• Engage in cross-functional projects that involve coding policy, system implementation, provider operations, and reimbursement methodologies.

⛳️ Requirements

• Background in CPT, HCPCS Level II, ICD-10, medical coding, reimbursement policies, claims processing, provider enrollment, healthcare operations, or Medicaid programs.

• Preferred certifications: CPC, COC, CCS, RHIA, or RHIT.

• Strong skills in critical thinking, analysis, and problem-solving.

• Capability to interpret regulatory guidance, evaluate operational impacts, and formulate recommendations.

• Experience in project management, including planning, coordinating, driving cross-functional initiatives, managing timelines, tracking deliverables, and ensuring project completion.

• Proven experience in leading meetings, coordinating stakeholders, drafting agendas, documenting meeting minutes, and tracking project deliverables.

• Exceptional written and verbal communication abilities.

• Competence in presenting recommendations, facilitating discussions, and creating formal documentation.

• Proficiency in Microsoft Office applications, including Excel, Word, PowerPoint, Teams, and SharePoint.

• Strong organization, prioritization, project management, and stakeholder engagement skills.

• Ability to pick up assigned equipment in Madison, WI, if selected.

• Residency in Wisconsin is preferred but not mandatory.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career advancement.

• Generous and flexible vacation policy.

• Educational assistance offered.

• Access to leadership and technical development academies.

• 401(k) employer match provided.

• Comprehensive health benefits package.

• Minimal travel required (0–10%).

• Assigned equipment for remote work will be provided.