Overview
A pediatrician-led medical group focused on improving care for children with special health care needs is seeking a Coding and Billing Specialist. The organization provides 24/7 virtual and in-home medical, behavioral, and social services to support families, providers, and health plans in delivering coordinated care for medically complex children.
Responsibilities
- Submit accurate and timely claims using CPT, HCPCS, ICD-10 codes, and modifiers
- Track and resolve denials, rejections, and underpayments with appropriate follow-up
- Validate patient eligibility, authorizations, and billing pathways for encounters
- Ensure correct use of telehealth, social determinants of health, and preventive care codes
- Coordinate with credentialing, partner success, and payer representatives to maintain compliance
- Review provider documentation and assign codes following ICD-10-CM, CPT, and quality reporting guidelines
- Identify and escalate documentation or coding gaps; issue coding queries as needed
- Educate providers on documentation improvements under Coding Manager guidance
- Support implementation and testing of documentation macros and encounter note templates
- Maintain and update internal billing rules matrix (payer, state, provider type, modifiers)
- Collaborate with Data & Analytics to monitor claim trends and accounts receivable performance
- Partner with Revenue Cycle and Clinical Operations to align workflows with payer requirements and business goals
- Assist with provider training, macro updates, and compliance education efforts
- Perform other assigned duties as needed
Requirements
- Certified Professional Coder (CPC) preferred
- 3 to 5 years of experience in physician billing and coding; pediatric experience preferred
- Proficiency with Athena EMR and Microsoft Excel
- Strong knowledge of CPT, HCPCS, ICD-10, HEDIS, and Medicaid/commercial payer requirements
- Experience with telehealth billing, capitation models, and quality measures is a plus
Compensation & Benefits
- Salary range: $55,000 to $65,000 plus annual bonus incentive
- Competitive benefits package including medical, dental, and vision insurance
- Healthcare and Dependent Care FSA; company-funded HSA
- 401(k) with 4% match, fully vested from day one
- Employer-paid short and long-term disability insurance
- Life insurance at one times annual salary
- 20 days PTO, 10 company holidays, and 2 floating holidays
- Paid new parent leave
- Eligibility for employee equity purchase program (as applicable)
Equal Opportunity
The employer is an equal opportunity organization committed to creating an inclusive environment. All qualified applicants will receive consideration without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.