Medical Coding & Billing Specialist

What You’ll Do

• Serve in a hybrid role blending coding precision with billing strategy.
• Ensure timely and accurate claims submission, compliance, and payment.
• Collaborate with providers, the data team, and partner operations to streamline workflows.
• Support documentation improvements and reduce denials.
• Validate eligibility, authorization, and proper billing pathways for all patient encounters.
• Coordinate 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.

What You Bring & How You Qualify

• Required: AAPC Certified Professional Coder (CPC)
• Experience: 3–5 years' experience in physician billing and coding (pediatrics preferred)
• Skills: 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 We Offer (Benefits + Perks)

• Salary range: $55,000-65,000
• Annual bonus incentive, competitive company benefits package
• Eligibility to participate in an employee equity purchase program (as applicable)
• Competitive medical, dental, and vision insurance
• Healthcare and Dependent Care FSA; Company-funded HSA
• 401(k) with 4% match, vested 100% from day one
• Employer-paid short and long-term disability
• Life insurance at 1x annual salary
• 20 days PTO + 10 Company Holidays & 2 Floating Holidays
• Paid new parent leave

What We Live By

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