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Cartwheel

The trusted mental health partner to schools.

Medical Coder – Medicaid, Behavioral Health

Medical Billing and CodingMedical Billing and CodingFull TimeRemoteSeniorTeam 51-200H1B No SponsorCompany SiteLinkedIn

Location

Massachusetts

Posted

42 days ago

Salary

$30 - $40 / hour

Seniority

Senior

Professional Certificate5 yrs expEnglish

Job Description

Medical Coder – Medicaid, Behavioral Health

Cartwheel

• Perform complex coding for CPT, HCPCS, and ICD-10 with a focus on high-impact, payer-sensitive services • Lead expansion and validation of new and underutilized codes (e.g., 90785, T1016, G-codes, state-specific Medicaid codes) • Apply and validate advanced modifier usage, including Medicaid and MCO-specific requirements, to ensure accurate reimbursement • Conduct deep-dive research on payer policies, fee schedules, and billing requirements across Medicaid, MCOs, and commercial plans • Establish coding standards and best practices across the organization • Serve as the subject matter expert (SME) for coding logic in automation and AI initiatives • Translate complex coding rules into scalable system logic for upstream claim automation • Perform manual chart reviews using Medical Decision Making (MDM) guidelines • Validate appropriate E/M level selection • Identify opportunities for appropriate upcoding where documentation supports higher acuity • Establish a 'gold standard' baseline for CPT coding accuracy • Lead analysis of coding-related denials and rejections, including diagnosis and modifier-related issues • Identify root causes and drive upstream fixes to prevent recurrence • Provide expert guidance on complex denial scenarios and appeals strategy, particularly for Medicaid and MCO plans • Support review of payment discrepancies (paid vs. expected based on fee schedules) • Provide coding insight into payer behavior and reimbursement variances across Medicaid and MCOs • Work closely with Clinical teams to ensure documentation supports coding accuracy • Partner with RCM leadership on billing strategy and optimization initiatives • Support training and documentation (e.g., SOPs, internal knowledge base content)

Job Requirements

  • Active coding certification (CPC, CCS, or equivalent)
  • 5+ years of medical coding experience, with strong Medicaid and MCO billing experience
  • Deep expertise in CPT, ICD-10, and HCPCS coding systems
  • Advanced knowledge of modifier usage, including state-specific Medicaid and MCO requirements
  • Proven experience conducting deep-dive research on new codes, payer policies, and reimbursement rules
  • Strong experience with E/M coding and Medical Decision Making (MDM)
  • Strong attention to detail, analytical thinking, and ability to interpret clinical documentation
  • Process improvement mindset with strong cross-functional communication skills
  • Experience in behavioral health or telehealth billing (preferred)
  • Background in denial analysis and revenue optimization (preferred)

Benefits

  • Competitive compensation
  • Flexible, remote engagement and a company provisioned laptop
  • Meaningful work with direct impact on student mental health outcomes across the country

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