Medical Billing and Coding Specialist

Summary

Join Imagine Pediatrics as a Medical Billing & Coding Specialist in a hybrid role combining coding precision with billing strategy. You will ensure timely and accurate claims submission, compliance, and payment. Collaborate with providers, the data team, and partner operations to streamline workflows, support documentation improvements, and reduce denials. Responsibilities include submitting clean claims with accurate codes, tracking and resolving denials, validating eligibility and authorizations, ensuring accurate code use, coordinating with credentialing and payer reps, reviewing provider documentation and assigning codes, identifying and escalating documentation gaps, educating providers on documentation improvement, supporting implementation of new documentation tools, maintaining the internal billing rules matrix, collaborating with the Data & Analytics team, partnering with Revenue Cycle and Clinical Ops, and supporting provider training. The ideal candidate possesses a CPC certification (preferred), 3–5 years' experience in physician billing and coding (pediatrics preferred), proficiency with Athena EMR and Microsoft Excel, and a deep understanding of CPT, HCPCS, ICD-10, HEDIS, and Medicaid/commercial payers. Strong communication, documentation, and problem-solving skills are essential. Imagine Pediatrics offers competitive benefits including medical, dental, and vision insurance, 401(k) with a match, paid time off, paid parental leave, and more.

Requirements

• 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
• Strong communication, documentation, and problem-solving skills
• Self-motivated, accountable, and collaborative

Responsibilities

• 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
• 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

Preferred Qualifications

• Certified Professional Coder (CPC) (Preferred)
• Experience with telehealth billing, capitation models, and quality measures a plus

Benefits

• 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