Coding & Billing Specialist

About the role

As a Medical Billing & Coding Specialist, you’ll serve in a hybrid role blending coding precision with billing strategy to ensure timely and accurate claims submission, compliance, and payment.

Responsibilities

• Submit clean, timely claims with accurate CPT, HCPCS, ICD-10 codes, and modifiers.
• Track and resolve denials, rejections, and underpayments with appropriate follow-up and resubmission.
• Validate eligibility, authorization, and proper billing pathways for all patient encounters.
• Ensure accurate use of telehealth, SDOH, and preventive care codes.
• Collaborate with credentialing, partner success, and payer reps to ensure claims compliance.
• Perform other duties as assigned.

Coding & Documentation Optimization

• Review provider documentation and assign accurate codes per ICD-10-CM, CPT, and HEDIS/quality reporting guidelines.
• Identify and escalate incomplete documentation or coding gaps; issue coding queries as needed.
• Educate providers under the guidance of the Coding Manager to drive documentation improvement.
• Support implementation and testing of new documentation macros and encounter note templates.

Cross-Team Workflow Ownership

• Maintain and contribute to the internal billing rules matrix (payer, state, provider type, modifiers).
• Collaborate with the Data & Analytics team to track claim trends, documentation compliance, and A/R performance.
• Partner with Revenue Cycle and Clinical Ops to align workflows with payer requirements and business goals.
• Support provider training, macro updates, and compliance education efforts.

Qualifications

• AAPC Certified Professional Coder (CPC) required.
• 3–5 years' experience in physician billing and coding (pediatrics preferred).
• Proficiency with Athena EMR and Microsoft Excel.
• Deep understanding of CPT, HCPCS, ICD-10, HEDIS, and Medicaid/commercial payers.
• Experience with telehealth billing, value-based care, capitation models, and quality measures (plus).

What You Bring & How You Qualify

• You’re passionate and committed to reimagining pediatric health care and creating a world where every child with special health care needs gets the care and support they deserve.
• You want an active role in building a diverse and values-driven culture.
• You accept that things change quickly in a startup environment and are willing to pivot quickly on priorities.

What We Offer (Benefits + Perks)

• The role offers a salary range of $55,000-65,000, in addition to an annual bonus incentive, competitive company benefits package, and eligibility to participate in an employee equity purchase program (as applicable).
• We offer competitive medical, dental, and vision insurance, a healthcare and dependent care FSA, a company-funded HSA, a 401(k) with a 4% match, and 20 days of PTO plus 10 Company Holidays & 2 Floating Holidays.
• We provide life insurance at 1x annual salary, paid new parent leave, and additional benefits to be detailed in offer.

Our Values

• Children First.
• Earn Trust.
• Innovate Today.
• Embrace Humanity.
• One Team, Diverse Perspectives.