Medical Coder and Billing Specialist

Summary

Join Nest Health as a Medical Coder & Billing Specialist and contribute to our mission of making comprehensive healthcare accessible. This remote role requires expertise in ICD-10-CM, CPT, and HCPCS coding, particularly within Medicaid, managed care, and value-based care settings. You will be responsible for accurate medical coding, ensuring compliance, and supporting efficient claims processing. Collaboration with providers and billing teams is crucial for optimal reimbursement. The ideal candidate possesses strong analytical skills, excellent communication, and a minimum of 5 years of relevant experience. Nest Health offers a comprehensive benefits package, including health insurance, parental leave, tuition reimbursement, and more.

Requirements

• Certification in CPC, CCS, RHIT, or equivalent (must be active and in good standing) required
• 5+ years' experience of medical coding, preferably in primary care, pediatrics, or behavioral health required
• Strong knowledge of Medicaid coding, managed care models, and risk-adjustment coding (HCC preferred) required
• Proficiency with Athena Health EHR and billing platforms required
• Familiarity with HIPAA, CMS guidelines, and payer-specific coding regulations required
• Strong analytical skills with attention to detail and accuracy
• Excellent written and verbal communication skills
• Ability to work independently and exercise sound judgement
• Strong understanding of coding compliance, medical necessity, and reimbursement principles
• Ability to navigate and maintain electronic health records (EHR) and coding/billing software

Responsibilities

• Analyze medical records, physician notes, and other relevant documentation to assign accurate ICD-10,CPT, and HCPCS codes
• Ensure proper sequencing and application of modifiers according to established coding guidelines
• Validate Medicaid, managed care, and value-based care coding requirements, including risk adjustment (HCC coding) where applicable
• Collaborate with physicians and providers to clarify documentation and ensure coding accuracy
• Stay updated on Medicaid policies, payer-specific guidelines, and regulatory changes
• Assist in internal and external coding audits to ensure compliance
• Provide guidance to providers and staff on documentation best practices
• Ensure coded data is integrated properly into the Athena billing system
• Support claim submission by ensuring accurate coding aligns with payer reimbursement policies
• Work to resolve claim denials, rejections, and coding-related discrepancies
• Assist with insurance eligibility verification, prior authorizations, and coverage clarifications
• Track and report on coding trends, claim accuracy, and revenue cycle metrics
• Respond to coding and billing related patient inquiries while ensuring HIPAA compliance
• Maintain up-to-date knowledge of billing regulations, claim adjudication processes, and payer contracts

Preferred Qualifications

• Experience in claims, denials management, and revenue cycle operations preferred
• Understanding of value-based care models and quality measure reporting preferred
• Experience with prior authorizations, eligibility verification, and insurance follow-up preferred
• Ability to train providers and staff on documentation and coding best practices preferred

Benefits

• Employer-sponsored health, dental, and life options
• Generous PTO
• Family- centric health support with access to Lyric’s comprehensive services for urgent care, behavioral health, psychology, and psychiatry for you and your entire family, including virtual veterinary care for your pets
• Company supported Parental Leave for both primary/non-primary care givers with options for a tiered return to work, and eligibility to receive additional hours PTO for Prenatal Care and Backup Childcare
• Receive reimbursement for work- related vehicle expenses, including commuting and travel costs, for staff who drive as part of their job responsibilities
• Opportunity to receive up to $3,000/year Tuition Reimbursement to support your educational and professional development by covering a portion of costs relating to fees, course materials, or other related expenses
• Receive employer sponsored short-term and long-term disability benefits to provide financial support in the event of illness or injury that prevents you from working
• Enrollment in 401 (k) Retirement Plan through Human Interest to help save for your future with flexible contribution options