Coding & Billing Specialist

About this role

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.

CPC Certification through AAPC required. Credentials will be verified prior to an offer of employment. What You’ll Do As a Medical Billing & Coding Specialist, you’ll serve in a 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.