Certified Medical Coder

Cartwheel • Cambridge, MA

13h • $30 - $40 • Remote

About The Position

We are seeking a highly experienced Certified Medical Coder with deep expertise in Medicaid and Managed Care Organizations (MCOs), advanced modifier application, and research of new/complex codes. This role will lead coding strategy and execution for expanding billable services, ensuring accuracy and compliance while enabling scalable automation. You will partner closely with the RCM Director to translate complex coding requirements into operational workflows and systems.
Role type: 1099 Contractor, 40 hours a week (M-F, EST hours)
Pay range: $30-40/hr
Location: Remote

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

Nice To Haves

• Experience in behavioral health or telehealth billing
• Background in denial analysis and revenue optimization

Responsibilities

• 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)

Benefits

• Mission-oriented and inclusive colleagues who will go to bat for you
• Competitive compensation
• Flexible, remote engagement with regular in-person retreats
• Meaningful work with direct impact on student mental health outcomes across the country

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed