Medicaid Solutions Consultant

Job Summary

A company is looking for a Medicaid Solutions Consultant who will advise health plans on policy interpretation and claims editing strategies.

Key Responsibilities

• Provide subject matter expertise to increase claim accuracy
• Develop customer-facing documentation for solutions in collaboration with internal teams
• Analyze and interpret Medicaid policies to guide claims processing and payment accuracy decisions

Required Qualifications

• 5+ years in CPT, HCPCS, ICD-10, and revenue coding within Medicaid programs
• 3+ years in Medicaid fee-for-service, managed care, and waiver programs
• 5+ years of experience in Medicaid policy, claims processing, and medical coding
• 5+ years of experience defining and scoping Payment Integrity Solutions for large enterprise healthcare customers