Coding & Billing Specialist

imaginepediatrics; United States; On-site; USD 55,000 - 65,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

HSA/FSA

401(k) match

PTO 20 days

Holidays

Equity program

Job summary

Imagine Pediatrics is a tech-enabled, pediatrician-led medical group transforming care for children with complex medical needs. We seek a Billing & Coding professional to drive clean claims, optimize documentation, and coordinate across teams to maximize revenue and compliance.

You will manage CPT/HCPCS/ICD-10 coding, assist with telehealth billing, and engage with payers to reduce denials while supporting provider training and macros implementation.

Qualifications

• CPC Certification required.
• 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 and value-based care is a plus.

Responsibilities

• Submit clean, timely claims with accurate CPT, HCPCS, ICD-10 codes, and modifiers.
• Track and resolve denials, rejections, and underpayments with 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.

Skills

CPC Certification

Physician billing

Pediatrics experience

CPT/HCPCS/ICD-10 knowledge

HEDIS & payers

Telehealth billing

Tools

Athena EMR

Microsoft Excel

Job description

Who We Are

Imagine Pediatrics 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

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 elevate 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:

• AAPC Certified Professional Coder (CPC) required
• 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, 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:

• 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 ho