Director of Reimbursement Research & Coding Strategy- Mom & Baby

Aeroflow Health • Asheville, NC

3d • Remote

About The Position

Aeroflow Health is seeking a Director of Reimbursement Research & Coding
Strategy to serve as the enterprise’s subject-matter expert in medical billing,
coding, payer policy, and reimbursement strategy across maternal health,
telehealth, and evolving clinical service lines.

This role is not operational billing management—rather, it is the strategic
engine ensuring Aeroflow codes, documents, bills, and delivers clinical services
in a way that is:

Compliant with federal and state regulations
Aligned to payer-specific rules and provider requirements
Optimized for accurate reimbursement and financial sustainability
Scalable as Aeroflow expands into new services and provider types

This leader will partner closely with payer relations, clinical leaders,
compliance, and business unit operators to research, interpret, and translate
payer rules into actionable billing and coding guidance.

Examples of supported areas include:

Lactation classes and clinical lactation services
CHW care coordination programs
Nutrition & perinatal education programs
Doula and birth support services
Telehealth medical visits and remote patient monitoring
New clinical services added across Aeroflow business units

Requirements

• 8+ years of experience in medical reimbursement, payer policy analysis, provider coding, or regulatory research.
• Demonstrated expertise in CPT/HCPCS/ICD-10 coding and payer policy interpretation.
• Experience with telehealth, maternal health services, or multi-state reimbursement environments.
• Strong understanding of Medicare, Medicaid, and commercial coverage policies.
• Experience evaluating reimbursement feasibility for new clinical or educational services.
• Advanced skills synthesizing policy, coding, and compliance into recommendations for senior leadership.

Nice To Haves

• Coding certifications such as CPC, CPB, CCS, CRC, or similar.
• Experience with perinatal or women's health services (e.g., lactation, doula, CHW, PT).
• Familiarity with payer negotiations or working alongside payer relations teams.
• Experience with virtual care delivery and hybrid clinical + product models.
• Background supporting multi-service, multi-state healthcare organizations.
• Working knowledge of documentation workflows, EHR systems, and billing logic automation.

Responsibilities

• Serve as Aeroflow’s enterprise expert on federal, state, and commercial reimbursement rules across telehealth, maternal health, DME-adjacent services, and emerging care models.
• Research and interpret coverage policies, billing rules, provider qualifications, supervision requirements, and documentation standards.
• Evaluate new service offerings for reimbursement viability, including coding pathways, provider credentialing needs, and payer-specific limitations.
• Maintain deep knowledge of CPT, HCPCS, ICD-10, and emerging codes relevant to maternal, perinatal, and education services.
• Develop and maintain a centralized coding strategy for classes, clinical services, virtual care, and hybrid product + service models.
• Ensure Aeroflow uses the correct codes, billing modifiers, place-of-service designations, and documentation requirements for each service type.
• Identify gaps or inconsistencies in billing and coding and recommend corrections.
• Assess provider types required for billable services (e.g., IBCLC, MD, NP, PA, PT, CHW, doula) and ensure alignment to payer rules.
• Work closely with the Payer Relations team to align internal billing methodology with contract terms and coverage decisions.
• Collaborate with clinical leaders to ensure documentation templates support compliant billing.
• Advise Product & Technology teams on documentation capture, coding logic, and workflow automation opportunities.
• Partner with Compliance to prepare for audits and ensure regulatory adherence.
• Build playbooks, coverage matrices, SOPs, and educational materials that translate payer rules into clear operational guidance.
• Serve as the escalation point for coding questions, new benefit review, and payer interpretation issues.
• Employee has an individual responsibility for knowledge of and compliance with laws, regulations, and policies.
• Compliance is a condition of employment and is considered an element of job performance
• Maintain HIPAA/patient confidentiality
• Regular and reliable attendance as assigned by your schedule
• Other job duties assigned

Benefits

• Competitive Pay, Health Plans with FSA or HSA options, Dental, and Vision Insurance, Optional Life Insurance, 401K with Company Match, 12 weeks of parental leave for birthing parent/ 4 weeks leave for non-birthing parent(s), Additional Parental benefits to include fertility stipends, free diapers, breast pump, Paid Holidays, PTO Accrual from day one, Employee Assistance Programs and SO MUCH MORE!!

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed