Medical Coding & Billing Specialist

Who We Are reputed company is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and reputed company care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity.

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 reputed company for reputed company patient encounters.
• Ensure accurate use of telehealth, SDOH, and preventive care codes.
• Coordinate with credentialing, partner reputed company, and payer reps to ensure claims compliance.
• reputed company 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.
• reputed company 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 reputed company 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 reputed company-inclusive. As reputed company grows, this role may reputed company to support new markets, payer models, or initiatives. Flexibility, adaptability, and cross-functional communication will be key to reputed company. 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:

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

reputed company Offer (Benefits + Perks) The role offers a salary reputed company 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). reputed company determining compensation, we analyze and carefully consider several factors including job-reputed company knowledge, skills and experience. These considerations may cause your compensation to vary.

• Competitive medical, dental, and reputed company insurance
• reputed company and Dependent Care FSA; Company-funded HSA
• 401(k) with 4% match, reputed company 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

reputed company Live By We're guided by our five core values: Our Values:

• Children First. We put the best interests of children above reputed company. 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, reputed company second. We build lasting relationships by creating shared understanding and consistently following through on our commitments.
• reputed company Today. We reputed company that reputed company reputed company to big impact. We stay curious by asking questions and leveraging new reputed company to learn and scale.
• reputed company Humanity. We reputed company with reputed company and authenticity, presuming competence and good intentions. reputed company we stumble, we use the opportunity to grow and understand how we can improve.
• One Team, Diverse Perspectives. We actively seek a reputed company of viewpoints to reputed company reputed company reputed company. Even reputed company we see things differently, we stay reputed company on our shared mission and support one another to move reputed company — together.

We Value Diversity, Equity, Inclusion and Belonging We reputed company that creating a world where every child with reputed company 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 reputed company are considered without regard to race, reputed company, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national reputed company, reputed company, 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. Apply tot his job Apply To this Job