Medical Coding & Billing Specialist

Imagine Pediatrics•United States (Remote), TX

9d•$55,000 - $65,000

About The Position

Imagine Pediatrics is a technology-enabled, pediatrician-led medical group providing 24/7 virtual-first and in-home medical, behavioral, and social care for children with special health care needs. The Medical Coding & Billing Specialist serves in a hybrid coding and billing role, ensuring accurate, compliant, timely claims submission and payment. The specialist works with providers, the data team, and partner operations to streamline workflows, improve documentation, and reduce denials. The role covers claims execution and follow-up, coding and documentation optimization, and cross-team workflow ownership. It may evolve as the organization grows into new markets, payer models, or initiatives, so flexibility, adaptability, and cross-functional communication are important.

Requirements

AAPC Certified Professional Coder (CPC) certification is required; credentials will be verified before an employment offer.
3–5 years of experience in physician billing and coding.
Proficiency with Athena EMR and Microsoft Excel.
Deep understanding of CPT, HCPCS, ICD-10, HEDIS, and Medicaid and commercial payers.
Passion and commitment to pediatric health care and supporting children with special health care needs.
Willingness to adapt and pivot quickly as priorities change in a startup environment.
Ability to contribute to a diverse, values-driven culture.

Nice To Haves

Pediatrics billing and coding experience.
Experience with telehealth billing, value-based care, capitation models, and quality measures.

Responsibilities

Submit clean, timely claims using accurate CPT, HCPCS, ICD-10 codes, and modifiers.
Track and resolve denials, rejections, and underpayments through follow-up and resubmission.
Validate eligibility, authorization, and appropriate billing pathways for patient encounters.
Ensure accurate use of telehealth, SDOH, and preventive care codes.
Coordinate with credentialing, partner success, and payer representatives to ensure claims compliance.
Review provider documentation and assign accurate codes according to ICD-10-CM, CPT, and HEDIS/quality reporting guidelines.
Identify and escalate incomplete documentation or coding gaps, and issue coding queries as needed.
Educate providers, under the guidance of the Coding Manager, to improve documentation.
Support implementation and testing of documentation macros and encounter note templates.
Maintain and contribute to the internal billing rules matrix covering payer, state, provider type, and modifiers.
Collaborate with the Data & Analytics team to track claim trends, documentation compliance, and accounts receivable performance.
Partner with Revenue Cycle and Clinical Operations to align workflows with payer requirements and business goals.
Support provider training, macro updates, and compliance education efforts.
Perform other duties as assigned.

Benefits

Annual bonus incentive.
Competitive company benefits package.
Eligibility to participate in an employee equity purchase program, as applicable.
Competitive medical, dental, and vision insurance.
Healthcare and Dependent Care FSA and a company-funded HSA.
401(k) with a 4% match, 100% vested from day one.
Employer-paid short- and long-term disability insurance.
Life insurance at 1x annual salary.
20 days of PTO, 10 company holidays, and 2 floating holidays.
Paid new parent leave.