Medical Coding & Billing Specialist

Who We Are

The 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 social 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.

CPC Certification through AAPC required. Credentials will be verified prior to an offer of employment.

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 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.

Role Scope

This job description outlines core duties but is not all-inclusive. As the company  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:

• AAPC Certified Professional Coder (CPC) required

• 3–5 years' experience in physician billing and coding (the company 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 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

What We Live By

We’re guided by our five core values

Our Values

• 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.

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 the company 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.