New Coding & Billing Specialist

What You’ll Do:

• 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.

Coding & Documentation Optimization:

• 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.

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.

What You Bring:

• 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.