Job Summary
We are seeking a highly motivated, detail-oriented, and experienced Pediatric/Family
Medicine Medical Coder & Biller to join our Revenue Cycle Management team.
The ideal candidate will have a strong understanding of pediatric medical coding, insurance billing, claim submission, reimbursement guidelines, and denial resolution. This individual will be responsible for ensuring accurate and timely coding and billing of pediatric services while maintaining compliance with insurance regulations and organizational standards.
Experience with athenaOne (Athenahealth) is highly preferred.
The successful candidate must be organized, dependable, productive, and capable of working independently while maintaining a high level of accuracy.
Key Responsibilities
Medical Coding & Charge Entry
● Review pediatric medical records and clinical documentation to assign accurate
ICD-10-CM, CPT, and HCPCS codes.
● Perform accurate and timely charge entry for pediatric office visits, preventive care,
immunizations, procedures, and other billable services.
● Apply appropriate coding guidelines for well-child visits, sick visits, newborn encounters,
developmental screenings, and preventive services.
● Ensure correct billing of vaccine administration codes, vaccine products, and applicable modifiers.
● Identify coding discrepancies, missing documentation, and potential billing errors before claim submission.
● Maintain compliance with current coding guidelines, payer policies, and applicable federal and state regulations.
Claims Processing & Insurance Billing
● Prepare, review, and submit accurate medical claims to commercial insurance carriers,
and managed care organizations.
● Verify billing information, insurance eligibility, coordination of benefits, and payer-specific requirements.
● Correct and resubmit rejected claims promptly.
● Ensure timely filing requirements are consistently met.
● Review claims for potential errors to improve first-pass claim acceptance and minimize denials.
Revenue Cycle Management & Productivity
● Manage assigned work queues efficiently and meet established productivity and accuracy expectations.
● Maintain accurate documentation of completed work and unresolved billing issues.
● Assist with identifying workflow inefficiencies and opportunities to improve reimbursement.
● Support departmental goals related to clean claims, denial reduction, timely submissions, and collection performance.
● Communicate coding and billing concerns to management in a timely manner.
Required Qualifications
● Minimum of 2 years of medical billing and/or coding experience, preferably in pediatrics.
● Strong knowledge of ICD-10-CM, CPT, HCPCS, and medical billing guidelines.
● Experience processing commercial insurance
● Understanding of pediatric preventive care, immunization billing, and evaluation and management coding.
● Experience with denial management, accounts receivable follow-up, and claim corrections.
● Familiarity with electronic health records (EHR) and practice management systems.
● Strong attention to detail, organizational skills, and problem-solving abilities.
● Ability to meet productivity goals while maintaining coding accuracy.
● Excellent written and verbal communication skills.
● Ability to work independently and collaborate with a team.
Preferred Qualifications
● Experience using athenaOne / Athenahealth.
● Previous experience working in a pediatric medical practice or multisite healthcare organization.
● Familiarity with commercial insurance plans, including Horizon BCBSNJ, Aetna, Cigna,
and UnitedHealthcare.
● Experience with CMS-1500 professional claims, clearinghouse rejections, and claim follow-up.
Performance Expectations The selected candidate will be expected to:
● Maintain a high level of coding and charge-entry accuracy.
● Complete assigned tasks within established productivity standards.
● Minimize preventable claim rejections and coding-related denials.
● Resolve billing discrepancies and outstanding work queues promptly.
● Demonstrate accountability, dependability, and attention to detail.
● Follow established revenue cycle policies, procedures, and compliance requirements.
Pay: $20.00 - $25.00 per hour
Work Location: Remote