Medical Coding & Billing Specialist

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

📋 Description

• Submit accurate and timely claims utilizing correct CPT, HCPCS, ICD-10 codes, and modifiers.

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

• Validate eligibility, authorization, and billing processes for patient encounters.

• Ensure precise application of telehealth, SDOH, and preventive care coding.

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

• Review provider documentation and assign the correct codes in accordance with ICD-10-CM, CPT, and HEDIS/quality reporting standards.

• Identify and escalate any incomplete documentation or coding discrepancies, issuing coding queries as needed.

• Educate providers on documentation enhancements with guidance from the Coding Manager.

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

• Maintain and contribute to the internal billing rules matrix.

• Work alongside Data & Analytics on claim trends, documentation compliance, and accounts receivable performance.

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

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

• Perform additional duties as assigned.

⛳️ Requirements

• AAPC Certified Professional Coder (CPC) certification is mandatory; credentials will be verified prior to employment offer.

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

• Proficiency in Athena EMR and Microsoft Excel is required.

• In-depth knowledge of CPT, HCPCS, ICD-10, HEDIS, and Medicaid/commercial payers is essential.

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

• Ability to demonstrate flexibility, adaptability, and effective cross-functional communication in a startup environment.

🏝️ Benefits

• Annual bonus incentive.

• Competitive medical, dental, and vision insurance options.

• Healthcare and Dependent Care FSA.

• Company-funded HSA.

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

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

• Life insurance equivalent to 1x annual salary.

• 20 days of paid time off (PTO).

• 10 Company Holidays.

• 2 Floating Holidays.

• Paid leave for new parents.

• Eligibility for employee equity purchase program, as applicable.

• Additional benefits outlined in the offer letter.