Medical Billing & Coding Specialist

Position Overview

Imagine Pediatrics is a tech-enabled, pediatrician-led medical group dedicated to reimagining care for children with special healthcare needs. We provide 24/7 virtual-first and in-home medical, behavioral, and social care, collaborating with families, providers, and health plans to overcome barriers to quality care. We aim to enhance existing care teams by offering an additional layer of support with compassion, creativity, and a commitment to children with medical complexity.

As a Medical Billing & Coding Specialist, you will play a hybrid role focused on coding precision and billing strategy to ensure timely and accurate claims submission, compliance, and payment. You will collaborate with providers, the data team, and partner operations to streamline workflows, improve documentation, and reduce denials.

Responsibilities

Billing & Claims Execution

• Submit clean, timely claims with accurate CPT, HCPCS, ICD-10 codes, and modifiers.
• Track and resolve denials, rejections, and underpayments through 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 representatives to ensure claims compliance.

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.
• Support the implementation and testing of new documentation macros and encounter note templates.

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.
• Support provider training, macro updates, and compliance education efforts.

Role Scope

This job description outlines core duties but is not all-inclusive. As Imagine Pediatrics grows, this role may evolve to support new markets, payer models, or initiatives. Flexibility, adaptability, and cross-functional communication will be key to success.

Requirements & Qualifications

• Passion: Committed to reimagining pediatric healthcare and creating a world where every child with special healthcare needs receives the care and support they deserve. Desire an active role in building a diverse and values-driven culture.
• Adaptability: Comfortable with change and willing to pivot quickly on priorities in a startup environment.
• Certification: Certified Professional Coder (CPC) (Preferred).
• Experience: 3–5 years of experience in physician billing and coding (pediatrics preferred).
• Technical Skills:
  • Proficiency with Athena EMR.
  • Proficiency with Microsoft Excel.
• Knowledge: Deep understanding of CPT, HCPCS, ICD-10, HEDIS, and Medicaid/commercial payers.
• Additional Experience (Plus): Experience with telehealth billing, capitation models, and quality measures.
• Soft Skills: Strong communication, documentation, and problem-solving skills. Self-motivated, accountable, and collaborative.

What We Offer (Benefits + Perks)

• Compensation: Hourly range of $26-$31 per hour.
• Incentives: Annual bonus incentive.
• Benefits Package: Competitive company benefits package.
• Equity: Eligibility to participate in an employee equity purchase program (as applicable).
  • Note: Compensation is determined by carefully considering job-related knowledge, skills, and experience, which may cause variation.
• Insurance: Competitive medical, dental, and vision insurance.
• Other: Healthcare and Dependent Care FSAs.

Company Information

Who We Are

Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity.