About Us
The Transgender Health & Wellness Center (TH&WC) is one of California's largest transgender-led nonprofit healthcare organizations, providing gender-affirming healthcare, behavioral health, electrolysis, laser hair removal, housing, employment services, youth programs, and community health navigation throughout California.
We are seeking an experienced Healthcare Reimbursement and Medical Coding Compliance Consultant to provide independent analysis and interpretation of medical billing regulations, coding guidance, payer policies, and reimbursement requirements.
Position Summary
The Independent Healthcare Reimbursement & Medical Coding Compliance Consultant will provide expert guidance regarding CPT®, HCPCS, ICD-10-CM, modifier usage, medical necessity documentation, payer policies, and reimbursement regulations. This position serves as an independent subject matter expert and advisor to organizational leadership regarding coding compliance and reimbursement interpretation. Liscensed California Health Attorney highly preferred but not required.
The ideal candidate possesses extensive knowledge of California Medi-Cal, Medicare, commercial insurance reimbursement, and healthcare regulatory requirements.
Essential Duties
- Interpret CPT®, HCPCS, ICD-10-CM, and modifier guidelines.
- Review documentation to determine coding accuracy and compliance.
- Research CMS, Medicare, Medi-Cal (DHCS), and commercial payer policies.
- Interpret Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs).
- Analyze payer denials and recommend appropriate coding strategies.
- Provide written reimbursement opinions supported by regulatory guidance.
- Review proposed billing workflows for regulatory compliance.
- Assist leadership in developing compliant billing procedures.
- Identify coding risks and recommend corrective actions.
- Prepare written reports and documentation suitable for audits or legal review.
- Collaborate with healthcare leadership regarding reimbursement strategy.
- Remain current on annual CPT, HCPCS, ICD-10-CM, CMS, and DHCS updates.
Preferred Areas of Expertise
Experience interpreting reimbursement for:
- Gender-affirming healthcare
- Electrolysis
- Laser hair removal
- Behavioral health
- Community clinics
- Medi-Cal managed care
- Medicare
- Commercial insurance
- Medical necessity documentation
- Prior authorization requirements
Minimum Qualifications
- Certified Professional Coder (CPC), CCS, RHIA, RHIT, or equivalent preferred.
- Minimum 10 years of medical coding, reimbursement, compliance, or healthcare consulting experience.
- Extensive knowledge of:
- CPT®
- HCPCS Level II
- ICD-10-CM
- CMS guidance
- Medicare regulations
- California Medi-Cal (DHCS)
- Commercial insurance reimbursement
- Strong research and technical writing skills.
- Ability to independently interpret healthcare regulations and payer policies.
- Excellent analytical and communication skills.
Preferred Qualifications
- Experience with nonprofit healthcare organizations.
- Experience with transgender healthcare.
- Experience supporting legal, compliance, or audit matters.
- Experience preparing written coding opinions.
- Familiarity with NextGen, Office Ally, or similar EHR/billing systems.
Independent Contractor Requirements
This is a 1099 Independent Contractor position.
The contractor:
- Determines their own work schedule.
- Provides services independently.
- Uses their own equipment and workspace.
- Is responsible for all applicable taxes and insurance.
- Is not eligible for employee benefits.
- May perform services for other clients consistent with applicable law and contractual obligations.
Why Join TH&WC?
- Help improve access to medically necessary gender-affirming healthcare.
- Work with one of California's leading transgender-led healthcare organizations.
- Flexible remote work.
- Opportunity to influence healthcare reimbursement policy and compliance.
- Meaningful work serving historically underserved communities.
To Apply
Please submit:
- Resume
- Certifications
- Brief summary of reimbursement and coding experience
- Relevant consulting or audit experience
- Desired hourly rate or project rate
Transgender Health & Wellness Center is committed to fostering an inclusive, respectful, and equitable environment. We welcome qualified applicants from all backgrounds and lived experiences.
Pay: $100.00 - $400.00 per hour
Work Location: Remote
