Medical Coder – Medicaid, Behavioral Health

Cartwheel

Remote Certified Medical Coder for Cartwheel tackling student mental health crisis. Focusing on Medicaid coding, billing strategy, and collaboration with clinical teams.

Posted 5/4/2026full-timeRemote • Massachusetts • 🇺🇸 United StatesMid-LevelSenior💰 $30 - $40 per hourWebsite

About the role

Key responsibilities & impact

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)

Requirements

What you’ll need

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

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

CPT codingICD-10 codingHCPCS codingmodifier usageE/M codingMedical Decision Making (MDM)denial analysisrevenue optimizationpayer policies researchbilling requirements

Soft Skills

attention to detailanalytical thinkingcross-functional communicationprocess improvement mindset

Certifications

CPCCCS