SummaryAs 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.
Your role in our missionPlay 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
What we're looking for- 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)
Professional Skills- 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
What you should expect in this role- Significant collaboration with operations teams, Business Analysts, and technical delivery teams
- Regular engagement with client stakeholders (DHS) on coding, policy, and operational alignment
- Opportunity to serve as a key bridge between business operations and system delivery
Work Environment- Fully remote opportunity from most US locations
- Work must be performed from within the contiguous United States (48 states)
- Limited travel (0-5%), depending on project and operational needs (though unlikely)
- Video cameras must be on during all interviews, internal, and client-facing meetings
- Working hours aligned to core business hours: 7:30 AM - 4:30 PM CST
- The deadline to submit applications for this posting is July 7, 2026
#LI-HC1#LI-Certified Professional Coder (CPC)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.
