[Hiring] Medical Biller @Modena Allergy + Asthma

Role Description

The Medical Biller/Coder is responsible for accurately reviewing, coding, and billing medical services for an Allergy & Asthma practice. This position ensures proper assignment of ICD-10-CM, CPT, and HCPCS codes, timely claim submission, and compliance with payer and regulatory requirements. The ideal candidate has experience in specialty physician coding and billing, strong attention to detail, and the ability to work independently in a remote environment.

Essential Duties and Responsibilities

• Medical Coding
  • Review provider documentation for accuracy and completeness.
  • Assign appropriate ICD-10-CM, CPT, and HCPCS codes for office visits, procedures, diagnostic testing, and treatments.
  • Ensure coding compliance with payer guidelines, Medicare regulations, and industry standards.
  • Identify documentation deficiencies and communicate with providers for clarification.
  • Stay current with coding updates, payer requirements, and regulatory changes.
• Medical Billing
  • Prepare and submit clean claims electronically to insurance carriers.
  • Review and correct claim edits and rejections before submission.
  • Monitor claim status and ensure timely reimbursement.
  • Process insurance and patient payments accurately.
  • Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERA) postings.
  • Assist with claim corrections, rebilling, and appeals as needed.
  • Maintain accurate patient and billing records within the practice management system.
• Specialty-Specific Responsibilities
  • Code and bill allergy testing procedures, immunotherapy services, biologic injections, pulmonary function testing, and related specialty services.
  • Verify that coding accurately reflects services provided and supports medical necessity requirements.
  • Assist in identifying coding and reimbursement opportunities while maintaining compliance.
• Compliance & Quality
  • Ensure compliance with HIPAA, payer policies, and federal regulations.
  • Participate in internal audits and quality assurance reviews.
  • Maintain confidentiality of patient and practice information.
  • Support continuous process improvement initiatives within the revenue cycle department.

Qualifications

• High school diploma or equivalent required; Associate degree preferred.
• Minimum 2 years of medical billing and coding experience, preferably in an Allergy & Asthma, Pulmonary, ENT, or specialty physician practice.
• Strong knowledge of ICD-10-CM, CPT, HCPCS, and medical terminology.
• Experience with claim submission, payment posting, denial management, and insurance billing.
• Proficiency with Electronic Medical Records (EMR) and practice management software.
• Strong attention to detail and accuracy.
• Excellent communication and organizational skills.

Preferred Qualifications

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Biller (CPB), or equivalent certification preferred.
• Experience coding allergy testing, immunotherapy, biologic medications, and respiratory procedures.
• Previous remote medical billing and coding experience.

Key Competencies

• Medical coding accuracy
• Knowledge of payer regulations
• Revenue cycle management
• Critical thinking and problem-solving
• Time management and organization
• Independent work ethic
• Effective communication

Work Environment

• Fully remote/work-from-home position.
• Requires a dedicated, secure, and HIPAA-compliant home office workspace.
• Reliable high-speed internet access required.
• Ability to work independently while meeting productivity and quality standards.
• Frequent use of computers, billing software, and communication platforms.

Performance Expectations

• Maintain coding accuracy and productivity standards.
• Ensure timely and accurate claim submission.
• Minimize coding-related denials and rework.
• Support optimal reimbursement and revenue cycle performance.
• Maintain compliance with all regulatory and payer requirements.

Physical Requirements

• Ability to stand, walk, and move throughout the clinic, if applicable, for extended periods; occasionally lift objects up to 25 lbs., bend, stoop, or reach as needed.
• Frequent use of hands and fingers for patient care and equipment operation.
• Must have normal (or corrected) vision and hearing and be able to respond quickly in a fast-paced clinical environment, if applicable.

Benefits

• Competitive compensation and professional development opportunities.
• Full-time employees are eligible for Modena Health’s benefits package, which includes medical, dental, and vision insurance, as well as a 401(k) retirement plan with employer matching.
• Paid time off (PTO), sick time, floating holidays, and holiday pay are also available to eligible full-time employees in accordance with company policy.
• Opportunity to shape the future of a thriving allergy and asthma practice in beautiful San Diego (and across our expanding network).
• A supportive, mission-focused culture where your contributions directly impact patient outcomes and team growth.

California Consumer Privacy Act (CCPA) Notice

Modena Health (“MH”) and Modena Allergy & Asthma ("MAA") complies with the California Consumer Privacy Act (“CCPA”). Personal information provided in the job application process will be collected, used, and retained in accordance with applicable privacy laws. Candidates may request additional information regarding the categories of personal information collected and the purposes for which it is used during the hiring process.