Hybrid Medical Billing & Coding Specialist — Pediatrics

Wwshemi; United States; Hybrid; USD 55.000 - 65.000; Vollzeit

Benefits dieser Stelle

Medical insurance

Dental and Vision insurance

HSA

401(k) with 4% match

Disability insurance

Life insurance

PTO and holidays

Parental leave

Zusammenfassung

Imagine Pediatrics is a tech-enabled pediatric medical group delivering 24/7 virtual and in-home care for children with special health care needs. We are seeking a Medical Billing & Coding Specialist in a hybrid role to ensure timely claims, accurate coding, and compliance.

You will collaborate with providers, the data team, and payer reps to streamline workflows and reduce denials. Ideal candidates have CPC certification, 3–5 years in pediatric billing/coding, proficiency in Athena EMR and

Qualifikationen

• 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.

Aufgaben

• Billing & Claims Execution: 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.
• Coding & Documentation Optimization: Review provider documentation and assign accurate codes per ICD-10-CM, CPT, and HEDIS/quality reporting guidelines.
• Identify and upscale 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.

Kenntnisse

CPC Certification

Billing experience (physician)

Athena EMR

Microsoft Excel

CPT coding

HCPCS coding

ICD-10 knowledge

HEDIS knowledge

Payer knowledge (Medicaid/Commercial)

Tools

Athena EMR

Microsoft Excel

Jobbeschreibung

Imagine Pediatrics is a tech-enabled pediatric medical group delivering 24/7 virtual and in-home care for children with special health care needs. We are seeking a Medical Billing & Coding Specialist in a hybrid role to ensure timely claims, accurate coding, and compliance.

You will collaborate with providers, the data team, and payer reps to streamline workflows and reduce denials. Ideal candidates have CPC certification, 3–5 years in pediatric billing/coding, proficiency in Athena EMR and