Certified Medical Coder

Join Cartwheel to help tackle the student mental health crisis. 

Cartwheel is an early-stage company building a new kind of mental health program for kids that puts schools at the center. We see our role as supporting school staff who see kids every single day. Instead of going around them, we collaborate with them. This means: 

• Earlier intervention
• Higher student and family engagement in care
• Better coordination among the trusted adults in a student’s life 

Kids shouldn't just aspire to get out of bed and drag themselves to class. They should be able to experience joy. They deserve to envision and build a life they’re excited to live. If you join Cartwheel, you’ll help make this vision a reality for millions of students across the country. We’re backed by top investors including Menlo Ventures, Reach Capital, General Catalyst, BoxGroup, and Able Partners, and we're looking for mission-driven teammates to join our team.

ABOUT THE ROLE

We are seeking a highly experienced Certified Medical Coder with deep expertise in Medicaid and Managed Care Organizations (MCOs), advanced modifier application, and research of new/complex codes. This role will lead coding strategy and execution for expanding billable services, ensuring accuracy and compliance while enabling scalable automation. You will partner closely with the RCM Director to translate complex coding requirements into operational workflows and systems.

Role type: 1099 Contractor, 40 hours a week (M-F, EST hours)
Pay range: $30-40/hr
Location: Remote

WHAT YOU’LL DO

Advanced Coding Accuracy & Optimization

• 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

MDM-Based Coding (E/M Optimization)

• 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

Denial Prevention & Resolution Support

• 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

Payment & Reimbursement Analysis

• 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

Cross-Functional Collaboration

• 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)

WHO YOU ARE 

Required

• 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

Preferred

• Experience in behavioral health or telehealth billing
• Background in denial analysis and revenue optimization

Please apply even if you don't meet all of the criteria. If your past experience doesn't perfectly match the job description, but you bring other relevant experience or skills, we'd still love to hear from you. You may be a great fit!

WHY YOU’LL LOVE CARTWHEEL

Our hope is that Cartwheel will be your best career decision! In addition to tackling one of the biggest challenges of our time, at a company well-positioned to do so, you’ll have: 

• Mission-oriented and inclusive colleagues who will go to bat for you
• Competitive compensation
• Flexible, remote engagement with regular in-person retreats
• Meaningful work with direct impact on student mental health outcomes across the country

Please note: This is a 1099 independent contractor role. Standard employee benefits (health insurance, 401K, paid leave, equity) are not included.

Cartwheel is proud to be an equal opportunity employer. We embrace diverse backgrounds and perspectives and an inclusive work environment. We're committed to equal employment opportunity regardless of race, color, religion, ancestry, national origin, gender, sexual orientation, disability status, or veteran status.

We participate in E-Verify. Please be prepared to provide acceptable documentation to verify your identity and work authorization

Cartwheel uses AI-assisted tools to support our hiring process, including scheduling, communications, and workflow management. All hiring decisions are made by humans. We are committed to fair, equitable hiring practices

Note: Please do not contact our Care, Provider, or Patient Services lines regarding job postings or application status. These teams support our patients and families and are not involved in the hiring process. For all recruitment-related questions, please email talent@cartwheelcare.org.