Medical Coding & Billing Specialist

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. What You’ll Do As a Medical Billing & Coding Specialist, you’ll serve in a hybrid role that blends coding precision with billing strategy to ensure timely and accurate claims submission, compliance, and payment. You’ll collaborate with providers, the data team, and partner operations to streamline workflows, support documentation improvements, and reduce denials. Billing & Claims Execution 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. Ensure accurate use of telehealth, SDOH, and preventive care codes. Coordinate with credentialing, partner success, and payer reps to ensure claims compliance. Perform other duties as assigned 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 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. What You Bring & How You Qualify First and foremost , you’re passionate and committed to reimagining pediatric health care and creating a world where every child with special health care needs gets the care and support they deserve . You want an active role in building a diverse and values-driven culture. Things change quickly in a startup environment; you accept that and are willing to pivot quickly on priorities. In this role, you will need: 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 Experience with telehealth billing, value-based care, capitation models, and quality measures a plus What We Offer (Benefits + Perks) The role offers a salary range of $55,000-65,000, in addition to an annual bonus incentive, competitive company benefits package, and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10…