Coding and Billing Specialist

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.

• 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

• 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.

• 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.

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.

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