Medical Coder & Billing Specialist

Nest Health relies on powerfully insightful data to ensure the delivery of excellent healthcare services. We are seeking an experience Medical Coder & Billing Support Specialist to ensure accurate coding, compliance, and efficient claims processing. This role is responsible for reviewing and coding medical documentation while supporting billing functions as needed. The ideal candidate has a strong understanding of OCD-10-CM, CPT, and HCPCS coding, particularly in Medicaid, managed care, and value-based care settings. They will work closely with providers, billing teams, and insurance payers to ensure accuracy, compliance, and optimal reimbursement.

- Medical Coding

- Analyze medical records, physician notes, and other relevant documentation to assign accurate ICD-10,CPT, and HCPCS codes

- Ensure proper sequencing and application of modifiers according to established coding guidelines

- Validate Medicaid, managed care, and value-based care coding requirements, including risk adjustment (HCC coding) where

applicable

- Collaborate with physicians and providers to clarify documentation and ensure coding accuracy

-Stay updated on Medicaid policies, payer-specific guidelines, and regulatory changes

-Assist in internal and external coding audits to ensure compliance

- Provide guidance to providers and staff on documentation best practices

-Billing & Revenue Cycle Support

- Ensure coded data is integrated properly into the Athena billing system

- Support claim submission by ensuring accurate coding aligns with payer reimbursement policies

- Work to resolve claim denials, rejections, and coding-related discrepancies

- Assist with insurance eligibility verification, prior authorizations, and coverage clarifications

- Track and report on coding trends, claim accuracy, and revenue cycle metrics

- Respond to coding and billing related patient inquiries while ensuring HIPAA compliance

- Maintain up-to-date knowledge of billing regulations, claim adjudication processes, and payer contracts

- Certification in CPC, CCS, RHIT, or equivalent (must be active and in good standing) required

- 5+ years' experience of medical coding, preferably in primary care, pediatrics, or behavioral health required

- Strong knowledge of Medicaid coding, managed care models, and risk-adjustment coding (HCC preferred) required

- Proficiency with Athena Health EHR and billing platforms required

- Familiarity with HIPAA, CMS guidelines, and payer-specific coding regulations required

- Experience in claims, denials management, and revenue cycle operations preferred

- Understanding of value-based care models and quality measure reporting preferred

- Experience with prior authorizations, eligibilty verification, and insurance follow-up preferred

- Ability to train providers and staff on documentation and coding best practices preferred

- Strong analytical skills with attention to detail and accuracy

- Excellent written and verbal communication skills

- Ability to work independently and exercise sound judgement

- Strong understanding of coding compliance, medical necessity, and reimbursement principles

- Ability to navigate and maintain electronic health records (EHR) and coding/billing software

- This is a remote role

- Prolonged periods sitting at a computer

- Family- centric health support with access to Lyric’s comprehensive services for urgent care, behavioral health, psychology, and

  psychiatry for you and your entire family, including virtual veterinary care for your pets 

- Company supported Parental Leave for both primary/non-primary care givers with options for a tiered return to work, and

 eligibility to receive additional hours PTO for Prenatal Care and Backup Childcare 

- Receive reimbursement for work- related vehicle expenses, including commuting and travel costs, for staff who drive as part of

  their job responsibilities 

- Opportunity to receive up to $3,000/year Tuition Reimbursement to support your educational and professional development by

covering a portion of costs relating to fees, course materials, or other related expenses

- Receive employer sponsored short-term and long-term disability benefits to provide financial support in the event of illness or

injury that prevents you from working

- Enrollment in 401 (k) Retirement Plan through Human Interest to help save for your future with flexible contribution options 

- Your role may be less defined than in other settings, with the need to wear multiple hats & juggle various responsibilities

- Learning opportunities- you will have the opportunity, at times, to function outside of your standard position and learn

  about new roles & areas

- Fast Paced- Startups often must move faster than traditional large companies. This means you may be asked to cope with

 or advise on quick changes regarding systems or processes

- Autonomy- You will need to be highly autonomous, as there is less structure and learning and development than at large

  orgs. This requires you to be able to learn asynchronously, as well as raise your hand when help is needed, or gaps are

  identified