Medical Coding & Billing Specialist

What You’ll Do As a Medical Billing & Coding Specialist, you’ll serve in a hybrid role that blends coding precision with billing strategy to ensure timely and accurate claims submission, compliance, and payment. You’ll collaborate with providers, the data team, and partner operations to streamline workflows, support documentation improvements, and reduce denials. Billing & Claims Execution 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. 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 escalation 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. Role Scope This job description outlines core duties but is not all-inclusive. As Imagine Pediatrics grows, this role may evolve to support new markets, payer models, or initiatives. Flexibility, adaptability, and cross‑functional communication will be key to success. What You Bring & How You Qualify First and foremost , 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. Things change quickly in a startup environment; you accept that and are willing to pivot quickly on priorities. In this role, you will need: Certified Professional Coder (CPC) (Preferred) 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, capitation models, and quality measures a plus 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). When determining compensation, we analyze and carefully consider several factors including job‑related knowledge, skills and experience. These considerations may cause your compensation to vary. 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 Additional benefits to be detailed in offer We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support they deserve requires a diverse team with diverse perspectives. We’re proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law. Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together. #J-18808-Ljbffr Imagine Pediatrics