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

As an Coding Policy Specialist at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve - a community's most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare's biggest challenges. Here are the details on this position.

Your role in our mission

Work in conjunction with the Medical Director and Innovation teams to develop and document clinical and coding content standards. Identify best practices in the company or industry and use in solution development.

Monitor and research changes in coding guidelines and determines impact to Gainwell programs.

Develop clinical and coding content that will drive decision-making and documentation for the Clinical Services, Quality and Appeals teams.

Develop training and education, and work with clinical teams to make sure that coding content standards are well understood by all levels of the organization.

Liaison with leadership of applicable departments to assure that coding content standards are the basis for decision-making and documentation performed by the operational teams.

Maintain expertise in current Gainwell clinical and coding program processes, workflows and outcomes.

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 that clients may be having or anticipate having with Gainwell clinical and coding review programs.

Participate in review and analysis of existing Gainwell clinical review programs; identify performance gaps and assist with developing plan to improve program performance

Generate ideas for new ideation, assist with developing review concepts, concept briefs and scoping analysis and documentation as assigned.

Assist in developing clinical content for Gainwell clinical programs and provide assistance as needed in integration

Performing research and scoping analysis for development of coding and clinical target and edits.

Support industry awareness of Gainwell as a coding leader, writing white papers, preparing and/or delivering conference presentations, etc.

Expert level experience with Microsoft Office products including Excel and Word

What we're looking for

10+ years reviewing and or auditing ICD 10 CM/PCS, MS-DRG, APR DRG claims and proficient with encoder products. In addition, experience with APC and EAPG preferred.

Inpatient Coding Certification Required (i.e CCS, CIC, RHIA, RHIT)

Ability to research State and Federal regulations, clinical policies, coding guidelines to develop and implement policies, clinical/coding resources, and tools to support HMS Clinical Claim Review products.

Independently perform research and analysis leveraging claims data to develop new audit strategies, solutions, edits and targets.

Deep experience with principals of inpatient and outpatient billing and coding audits with ability to provide Subject Matter Expert (SME) level support to the clinical organization.

What you should expect in this role

Fully Remote Opportunity

Note

Video cameras must be used during all interviews, as well as during the initial week of orientation.

The deadline to submit applications for this posting is 10/31/2024.

The pay range for this position is $69,400.00 - $99,200.00 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.