Senior Business Analyst, Medical Coding & Policy

Gainwell Technologies LLC•Any city, OH

1d•$69,400 - $99,200•Remote

About The Position

As a Senior Business Analyst, Medical Coding & Policy at Gainwell, you will combine deep medical coding expertise with strong business analysis capability to support healthcare system operations and implementations. In this role, you will act as a bridge between operational areas, delivery teams, and client stakeholders, ensuring that coding, billing, and policy requirements are clearly defined, accurately implemented, and well documented. You will play a key role in strengthening alignment between functional areas and delivery, translating complex concepts into clear, actionable guidance that supports both system solutions and day-to-day operations for Medicaid programs.

Requirements

Six or more years of experience as a Business Analyst, coding analyst, or in a related healthcare role
Certified Professional Coder (CPC) or equivalent deep medical coding expertise (required)
Experience supporting healthcare or Medicaid claims processing, coding, or related system implementations (required)
Strong knowledge of requirements elicitation and writing, SDLC/PLC processes, and alignment of requirements to testing and validation activities
Experience working across functional areas such as claims, billing, policy, and operations
Sufficient technical aptitude to understand system and claims processing impacts (not a development role)

Nice To Haves

Proven experience developing clear, structured requirements, claims processing instructions, policy documentation, or operational guidance
Strong ability to translate complex coding, billing, and policy concepts into clear, plain-language documentation
Strong communication skills with the ability to engage directly with client stakeholders and influence outcomes
Strong attention to detail and ability to produce high-quality deliverables with minimal rework
Ability to work independently while collaborating effectively across operational and delivery teams

Responsibilities

Play a key role in delivering high-quality business analysis and operational support across both functional area maintenance and project initiatives.
Develop and own structured solution artifacts and operational deliverables that define coding, billing, or policy-related changes, driving them end-to-end from initial definition through review, coordination, testing alignment, implementation, and closure.
Elicit, document, and manage business, functional, and operational requirements, translating complex medical coding and billing concepts into clear, actionable deliverables.
Author and maintain claims processing instructions, policy documentation, and operational guidance in clear, plain language to support both internal teams and client stakeholders.
Analyze coding, billing, and claims-related processes and system impacts, ensuring alignment across functional areas and with technical solutions.
Serve as a bridge between operations, Business Analysts, and delivery teams, ensuring consistent understanding and application of coding and policy requirements.
Participate in and support requirements workshops, design sessions, operational discussions, and client walkthroughs.
Ensure adherence to established standards, templates, and documentation practices across all deliverables.
Maintain project coordination and communication activities, including capturing and distributing meeting outcomes, tracking status of work items, and providing updates to Project Managers, Business Leads, and stakeholders.
Provide guidance to other BAs and functional teams on coding, billing, and policy-related topics, strengthening consistency across the team.