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.

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

Medical Coding and Billing Specialist

Key skills