Coding & Billing Specialist

Job description

**This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Coding & Billing Specialist based in the United States.** This role combines medical coding expertise with billing operations to help ensure accurate, compliant, and timely reimbursement for pediatric healthcare services. You will play a key part in submitting clean claims, resolving billing issues, improving documentation, and reducing avoidable denials. Working closely with providers, revenue cycle teams, data specialists, and payer representatives, you will help strengthen workflows across a growing healthcare organization. The position offers an opportunity to influence both day-to-day claims performance and longer-term improvements in coding and documentation practices. You will work in a collaborative, fast-moving environment where priorities can evolve as new markets, payer models, and care initiatives are introduced. This is an ideal opportunity for a detail-oriented medical billing professional who combines coding precision, analytical thinking, and a strong commitment to improving care for children with complex healthcare needs. ### Accountabilities: - Submit accurate, timely, and compliant claims using appropriate CPT, HCPCS, ICD-10 codes, modifiers, and applicable billing requirements. - Track and resolve claim denials, rejections, and underpayments through investigation, follow-up, correction, and resubmission. - Validate patient eligibility, authorizations, and appropriate billing pathways for individual encounters. - Ensure accurate application of telehealth, social determinants of health, preventive care, and other relevant coding requirements. - Coordinate with credentialing teams, partner operations, and payer representatives to resolve billing and compliance issues. - Review provider documentation and assign accurate codes in accordance with ICD-10-CM, CPT, HEDIS, and quality reporting guidelines. - Identify documentation deficiencies and coding gaps, escalating issues and issuing coding queries when additional clarification is required. - Support provider education and documentation improvement initiatives under the direction of the Coding Manager. - Assist with the development, implementation, and testing of documentation macros, encounter templates, and coding workflows. - Maintain and improve internal billing rules covering payer requirements, state-specific regulations, provider types, modifiers, and billing pathways. - Collaborate with Data & Analytics teams to monitor claim trends, documentation compliance, accounts receivable performance, and other revenue cycle metrics. - Partner with Revenue Cycle and Clinical Operations teams to align billing processes with payer requirements and organizational objectives. - Support provider training, compliance education, workflow updates, and other initiatives that improve coding and billing accuracy. - Adapt to evolving responsibilities as the organization expands into new markets, payer models, and healthcare initiatives. ### Requirements: - **AAPC Certified Professional Coder (CPC) certification is required**, with credentials subject to verification before an employment offer. - 3–5 years of professional experience in physician medical billing and coding; pediatric experience is strongly preferred. - Strong working knowledge of CPT, HCPCS, ICD-10, HEDIS, Medicaid, and commercial payer requirements. - Proficiency with Athenahealth or similar electronic medical record systems and Microsoft Excel. - Demonstrated understanding of medical claims workflows, coding compliance, eligibility, authorizations, and denial management. - Strong attention to detail and the ability to identify coding, documentation, and billing discrepancies accurately. - Analytical and problem-solving skills, with the ability to investigate claim trends and determine appropriate corrective actions. - Strong communication and collaboration skills, with the ability to work effectively with providers, operational teams, data specialists, and external payer stakeholders. - Ability to manage multiple priorities in a fast-paced environment while maintaining accuracy and meeting deadlines. - Adaptable and comfortable working in an evolving organization where priorities, workflows, and responsibilities may change quickly. - Passion for improving healthcare outcomes and supporting children with complex medical needs. - Experience with telehealth billing, value-based care, capitation models, multi-state billing, or quality measures is a plus. - Experience working in pediatrics, internal medicine, startups, or other rapidly evolving healthcare environments is advantageous. ### Benefits: - Annual salary range of **$55,000–$65,000 USD**, with compensation determined based on job-related knowledge, skills, experience, and other relevant factors. - Annual bonus incentive opportunity. - Competitive medical, dental, and vision insurance. - Healthcare and Dependent Care Flexible Spending Accounts. - Company-funded Health Savings Account. - 401(k) plan with a **4% employer match**, fully vested from day one. - Employer-paid short-term and long-term disability coverage. - Life insurance equal to **1x annual salary**. - **20 days of PTO**, plus 10 company holidays and 2 floating holidays. - Paid new-parent leave. - Eligibility to participate in an employee equity purchase programme, where applicable. - Additional benefits may be available and will be detailed as part of the offer. - Opportunity to contribute to a mission-driven healthcare environment focused on improving care and support for children with complex medical needs. - Collaborative, values-driven culture emphasizing trust, innovation, empathy, and diverse perspectives.