Senior Business Analyst, Medical Coding & Policy

Summary

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.

Your role in our mission

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

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
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