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LTC Medical Coding Policy Auditor

Date:  Jul 3, 2024

Any city, WI, US, 99999

Req ID:  25134

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.



We are seeking a talented individual for an LTC Medical Coding Policy Auditor who is responsible for performing coding reviews of medical records and/or other documentation to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided.  This involves accessing proprietary systems to audit medical records, accurately document findings and providing policy/regulatory support for determination. The candidate must have an extensive background in either facility-based inpatient coding and/or outpatient coding edits and has a high level of understanding in reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG and APR-DRG, ASC and APC payment systems. The individual selected will be working as a Medical Coding Policy subject matter expert in the Bureau of Programs and Policy at the Division of Medicaid Services, Wisconsin Department of Health Services, taking direction from bureau leadership.

Your role in our mission

  • Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Draws on advanced ICD-10 coding expertise to substantiate conclusions. Utilizes proprietary auditing systems with a high level of proficiency to document audit determinations and rationale. 
  • Review CPT & HCPCS Level II national procedure code set changes and determine if codes used by the Waiver Programs or the State Plan Process for current LTC Processes are affected. Facilitate management review of LTC coverage recommendations, liaison with Gainwell Technologies on coverage decisions and MMIS configuration, and ensure the User Guides/Handbooks/Encounter Guides get updated quarterly.
  • Review yearly changes to diagnosis code set additions, deletions and changes when published and determine if codes used by the Waiver Programs or the State Plan Process for current LTC Processes are affected.  Consider systems impacts/involvement due to the LTC encounter and LTC provider enrollment projects.
  • Serve as a medical coding subject matter expert on the LTC medical coding workgroup that is supporting several MMIS projects (ex. LTC Encounter, LTC Provider Enrollment and LTC Minimum Fee Schedule).
  • As needed, research and respond to medical coding questions from our contracted Family Care Providers on operationalizing their obligations for payment based on ForwardHealth Policy.  Requires collaboration with BRS, BQO and BPP to ensure response is accurate and consistent with systems (encounter and provider and user guides/handbooks) and sends the response directly to the plan.

What we're looking for

  • Proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology. (certification desired but not required)
  • A thorough understanding of the APR-DRG, AP-DRG, and MS-DRG
  • Must be a Wisconsin resident.
  • Experience in medical record coding and auditing on the payer side of the process required.
  • Proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., Microsoft Teams, Zoom, etc.

What you should expect in this role

  • Remote (work from home) environment in the state of Wisconsin
    • A company computer is provided for work use.
  • This is a full-time permanent regular salaried (W-2) employee position.
    • Schedule is Monday through Friday 8 AM to 5 PM local time.
    • Benefits on first day of employment
      • Medical, Dental, Vision
      • Paid Time Off (sick days, holidays, and vacation with manager approval)
    • Company match 401K and other benefits available within months of starting.
  • In order to effectively work remotely with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide better performance.
    • To Test your internet download and upload speed:
      • Go to Google
      • Search for Internet Speed Test
  • Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.





This position is intended for pipelining. We will accept applications on an ongoing basis.


The pay range for this position is $64,500.00 - $92,200.00 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.

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