Reimagining pediatric health care. Together.
Medical Coding and Billing Specialist
Location
United States
Posted
3 days ago
Salary
$55K - $65K / year
Seniority
Senior
Job Description
Medical Coding and Billing Specialist
Imagine Pediatrics
• 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. • 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.
Job Requirements
- 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
Benefits
- 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 Company Holidays & 2 Floating Holidays
- Paid new parent leave
- Additional benefits to be detailed in offer
Related Guides
Related Categories
Related Job Pages
More Medical Billing and Coding Jobs
Coding Specialist - Surgical Services
IES - Integrative Emergency ServicesIES, which stands for Integrative Emergency Services, delivers specialized healthcare solutions in emergency medicine, driven by a commitment to physician-led c
Title: Coding Specialist - Surgical Services Location: Remote Full Time Revenue Cycle Management Experienced Job Description: Integrative Emergency Services, LLC (“IES”) is seeking a Coding Specialist with emphasis on surgical services. The Coding Specialist is responsible for accurate professional fee coding and documentation review for assigned surgical service lines (URSA/NTCC/TSN). This role evaluates medical records to ensure proper CPT, HCPCS Level II, and ICD-10-CM code assignment in accordance with payer guidelines and regulatory standards. The Coding Specialist supports documentation integrity, identifies coding compliance risks (including undercoding, overcoding, and unbundling), and contributes to clean claim submission and optimal reimbursement through coding analysis, audits, and special projects. Candidates can work in either a hybrid or remote setting. If remote, must reside in a state IES operates in: AZ, CO, TX, OK, IN, MO, AL, SC, FL IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and physicians in pursuit of the highest quality health care. ESSENTIAL DUTIES AND RESPONSIBILITIES The responsibilities listed here represent the majority of the role but are not all-inclusive; other duties may be assigned. - Accurately assign CPT, ICD-10-CM, and HCPCS Level II codes for professional surgical services based on thorough medical record review. - Evaluate medical records for proper code assignment, completeness, accuracy, and support of medical necessity. - Ensure coding compliance with CMS, commercial payer, and regulatory guidelines. - Identify and address undercoding, overcoding, modifier misuse, and unbundling issues. - Apply appropriate modifiers and ensure correct provider, place of service, and payer selection. - Conduct claim review to support clean claim submission and reduce denials. - Audit coding accuracy through ad hoc reports, focused reviews, and special projects. - Analyze coding-related denials and recommend corrective actions. - Review payer policies and stay current on annual coding updates and regulatory changes. - Collaborate with providers and operational leadership to clarify documentation and improve coding specificity. - Maintain productivity and quality benchmarks established by the department. - Serve as a subject matter resource for surgical coding guidance within assigned service lines. QUALIFICATIONS Knowledge, Skills, Abilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. - High-level knowledge of general surgery-related medical terminology, anatomy, and pathophysiology. - Strong understanding of CPT procedure coding, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis coding. - Knowledge of coding in surgical practices, ambulatory surgery centers, and hospital settings. - Ability to evaluate documentation for medical necessity and coding compliance. - Strong understanding of National Correct Coding Initiative (NCCI) edits and bundling guidelines. - Ability to audit reports, conduct focused reviews, and participate in special projects. - Advanced analytical and problem-solving skills. - High attention to detail and accuracy. - Proficiency with EHR systems, practice management systems, and claim scrubber tools. - Strong written and verbal communication skills. - Ability to manage multiple priorities and meet deadlines. - Proficiency in Microsoft Office applications. - Ability to maintain confidentiality and exercise professional discretion. Education / Experience: Include minimum education, technical training, and/or experience preferred to perform the job. Required: - High school diploma or equivalent. - Minimum five (5) years of professional medical coding experience. - Strong surgical coding experience required. - Active coding certification through: American Academy of Professional Coders (AAPC) (ie. CPC), or American Health Information Management Association (AHIMA) (ie. CCS-P). Preferred: - Certified Professional Medical Auditor (CPMA) through AAPC. - Experience conducting internal coding audits. - Experience with CMS Part B and commercial payer reimbursement methodologies. PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. - Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus - While performing the duties of this job, the employee is regularly required to talk and hear - Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms. - Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to remaining seated for periods of time to perform computer-based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.) - Occasionally lift and/or move up to 20-25 pounds - Fine hand manipulation (keyboarding) WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job - Hybrid office environment or flexible for remote - Corporate office: 4835 Lyndon B Johnson Fwy, Dallas, TX 75244 - If remote, must reside in a state IES operates in - Arizona, Colorado, Texas, Oklahoma, Indiana, Missouri, Alabama, South Carolina, & Florida TRAVEL: - Some travel, including overnight and local, may be required as business needs dictate.
Outpatient Coder II
Northwell HealthNorthwell Health, headquartered in New Hyde Park, New York, is the largest healthcare provider and private employer in New York State. The system serves over 8
Title: Outpatient Coder II Location: Remote, Danbury, Connecticut Department: Professional & Corporate Job Description: Professional & Corporate Description Position at Nuvance Health REMOTE POSITION Northwell is the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, Connecticut and beyond, thanks to philanthropic support from our communities. Northwell is New York State’s largest private employer with over 104,000 employees — including members of Northwell Health Physician Partners — who are working to change health care for the better. Summary: Accurately codes and abstracts outpatient medical records for reimbursement and statistical purposes using established coding guidelines. Reviews coding and amends coding edits to assure compliance with all applicable regulations. Responsibilities: - Codes all outpatient medical records in a timely and accurate manner according to department policy. - Defines and transforms verbal descriptions of diseases, injuries, and procedures into numerical designations (codes) using ICD-10-CM and CPT-4 according to established coding guidelines. - Initiates a physician/department query when there is conflicting, incomplete, or ambiguous documentation in the record or additional information is needed for accurate coding. - Enters all required information accurately into computer system for reimbursement and statistical purposes. As applicable based on facility workflow, independently reconcile charges for areas of responsibility. Uses patient schedule together with billing slips to identify missing charges. researches and resolves discrepancy so charge keyed reflect services delivered. - Performs ICD-10-CM diagnostic and CPT-4 coding at a minimum accuracy rate of 95%. - Remains abreast of all applicable Federal, State, regulatory and hospital-specific coding guidelines. - Applies applicable guidelines to all cases coded to ensure accuracy of selected codes. - Accesses and research applicable reference materials to further support decision-making in code selection. - Participates in Performance Improvement/Quality Assurance activities. - Reports on software and hardware problems. - Attends required educational sessions (webinars, conferences etc.) to maintain and enhance coding certification(s) - Maintains and Model the Organizations values. - Demonstrates regular, reliable and predictable attendance. - Performs other duties as required. Education Skills Experience: Basic familiarity with MS Office applications (Word, Excel. Outlook) Usage of coding manuals and regulatory websites for research Certification from the America Academy Professional Coders (AAPC) or the American Health Information Management Association (AHIMA): CPC, CPC-H, CCS, CCS-P, RHIA, RHIT, or specialty certification required. Working Conditions: Manual: significant manual skills/motor coord & finger dexterity Occupational: Some occupational risk Physical Effort: Medium to Heavy effort. May exert up to 35 lbs. force Physical Environment: Some exposure to dirt, odors, noise, human waste, etc. Company: Nuvance Health Org Unit: 2069 Department: CODERS - PROFESSIONAL & FACILITY CHARGING and CODING Exempt: No Salary Range: $26.48 - $50.49 Hourly
Coder I
CHI Health ClinicFrom primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.
Role Description As our Clinic Coder I, you will play a crucial role in the financial integrity and data accuracy of our organization, responsible for abstracting and coding patient records in strict compliance with established coding, billing, and data collection guidelines. This entry-level medical coding specialist position focuses on less complex coding, providing a foundational opportunity within our Revenue Cycle division to directly contribute to effective healthcare operations. - Meticulously review medical and pathology records to determine the most appropriate diagnoses. - Accurately abstract information into our coding systems. - Apply ICD-9-CM and CPT-4 coding rules and guidelines to assign MS-DRGs and APCs. - Sequence diagnostic and procedural codes. - Provide necessary codes to various departments upon request. - Enter and validate charges. - Identify and resolve discrepancies between charges and coded procedures. - Collaborate with the Coding Manager to rectify accounts, ensuring precise and compliant billing for patient care. Qualifications - Strong attention to detail. - Commitment to accuracy. - Foundational understanding of medical terminology and coding principles. - Proactive attitude towards learning. - Adherence to established policies and procedures. Requirements - Preferred certifications include: - Certified Professional Coder (CPC) - Certified Professional Coder Hospital Apprentice (CPC-HA) - Certified Professional Coder Apprentice (CPCA) - Certified Coding Associate (CCA) - Cardiology Coding (CCC) - Certified Coding Specialist (CCS) - Certified Coding Specialist - Physician Based (CCS-P) Company Description From primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.
Supervisor Coding
CHI Health ClinicFrom primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.
Role Description As our Supervisor, Coding, you will be a pivotal leader within our Revenue Cycle division, directly overseeing daily coding operations and ensuring the highest standards of timeliness, accuracy, and efficiency in the assignment of ICD-9/10, CPT, and HCPCS codes. This role is critical for maintaining compliance, optimizing reimbursement, and serving as a technical expert for complex coding and billing issues across our healthcare ministry. - Supervise, coach, and train a dedicated team of coders and data entry specialists. - Foster a positive work environment and address performance issues when needed. - Conduct quality reviews and provide essential education and training on coding processes, policies, and systems. - Resolve complex coding problems. - Act as a key liaison to coordinate with physicians, practice managers, and other stakeholders to resolve issues related to coding, billing, and documentation. - Contribute directly to coding compliance and charge capture optimization. Qualifications - Bachelor's degree and a minimum of one year of experience in the discipline, or three years if without a prior healthcare billing background. - Essential certifications such as Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Registered Health Information Administrator (RHIA) are required. Requirements - Bachelors Other and minimum of 1 year experience in the discipline, upon hire or - 3 years’ experience in the discipline or - Masters Other and no experience, upon hire and - Certified Professional Coder, upon hire or - Certified Coding Specialist - Physician Based, upon hire or - Registered Health Information Technician, upon hire Preferred - Prior Healthcare Billing Experience

