Coding & Billing Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Act in a dual capacity that merges coding accuracy with billing strategy.

• Submit precise and timely claims using correct CPT, HCPCS, ICD-10 codes, and modifiers.

• Monitor and address denials, rejections, and underpayments through diligent follow-up and resubmission.

• Confirm eligibility, authorization, and billing procedures for patient interactions.

• Ensure the correct application of telehealth, SDOH, and preventive care codes.

• Collaborate with credentialing, partner success, and payer representatives to ensure claims compliance.

• Execute additional tasks as assigned.

• Review provider documentation and accurately assign codes per ICD-10-CM, CPT, and HEDIS/quality reporting standards.

• Recognize and escalate any incomplete documentation or coding discrepancies; issue coding queries as necessary.

• Provide education to providers under the direction of the Coding Manager.

• Assist in the implementation and testing of documentation macros and encounter note templates.

• Maintain and enhance the internal billing rules matrix.

• Work in collaboration with Data & Analytics to analyze claim trends, documentation compliance, and accounts receivable performance.

• Partner with Revenue Cycle and Clinical Operations to align workflows with payer requirements and organizational objectives.

• Aid in provider training, macro updates, and compliance education initiatives.

• Support the development of new markets, payer models, or initiatives as the role evolves.

⛳️ Requirements

• AAPC Certified Professional Coder (CPC) certification is mandatory; credentials will be verified before extending an employment offer.

• 3–5 years of experience in physician billing and coding, with a preference for pediatrics.

• Proficient in Athena EMR and Microsoft Excel.

• Comprehensive knowledge of CPT, HCPCS, ICD-10, HEDIS, and Medicaid/commercial payers.

• Experience in telehealth billing, value-based care, capitation models, and quality measures is advantageous.

• A strong passion and commitment to transforming pediatric healthcare.

• Ability to quickly adapt to changing priorities in a startup setting.

🏝️ Benefits

• Annual bonus incentive.

• Competitive company benefits package.

• Eligibility for the employee equity purchase program (as applicable).

• Comprehensive medical, dental, and vision insurance.

• Healthcare and Dependent Care Flexible Spending Account (FSA).

• Company-funded Health Savings Account (HSA).

• 401(k) plan with a 4% match, fully vested from day one.

• Employer-paid short-term and long-term disability insurance.

• Life insurance coverage at 1x annual salary.

• 20 days of paid time off (PTO).

• 10 Company holidays.

• 2 floating holidays.

• Paid leave for new parents.

• Additional benefits will be outlined in the employment offer.