Medical Coding & Billing Specialist (United States)

United States

About us

Pomelo Care is a multi-disciplinary team of clinicians, engineers and problem solvers who are passionate about improving care for moms and babies. We are transforming outcomes for pregnant people and babies with evidence-based pregnancy and newborn care at scale. Our technology-driven care platform enables us to engage patients early, conduct individualized risk assessments for poor pregnancy outcomes, and deliver coordinated, personalized virtual care throughout pregnancy, NICU stays, and the first postpartum year. We measure ourselves by reductions in preterm births, NICU admissions, c-sections and maternal mortality; we improve outcomes and reduce healthcare spend.

About us

Pomelo Care is a multi-disciplinary team of clinicians, engineers and problem solvers who are passionate about improving care for moms and babies. We are transforming outcomes for pregnant people and babies with evidence-based pregnancy and newborn care at scale. Our technology-driven care platform enables us to engage patients early, conduct individualized risk assessments for poor pregnancy outcomes, and deliver coordinated, personalized virtual care throughout pregnancy, NICU stays, and the first postpartum year. We measure ourselves by reductions in preterm births, NICU admissions, c-sections and maternal mortality; we improve outcomes and reduce healthcare spend.

Role Description

Your north star: In this role, you will be accountable for the accurate and timely submission and reconciliation of claims for the Pomelo medical practice including: 

• Reviewing and submitting claims within payor guidelines to ensure timely and accurate filing
• Reporting on aging encounters, and partnering with clinicians to resolve them, ensuring compliance with internal best practices
• Querying the clinical team to obtain additional, clarifying documentation to improve the completeness of encounter data 
• Resolving and appealing claims denials, and working with the Revenue Cycle Manager to improve workflows and optimize our claim submission process
• Reconciling ERAs by resolving holds, manually posting payments and adjudicating claims
• Collaborating with other teams to identify and update missing patient demographic and insurance data 
• Accurately applying appropriate CPT and ICD-10 codes for each encounter, adhering to federal and state rules and agreed-upon coding guidelines with our partner MCOs

Who you are

• 3+ years experience in revenue cycle support role 
• 2+ years outpatient medical coding experience preferably in primary or maternal care
• Coding certification not required but a plus
• Proficiency in using medical billing software and EHR systems
• Proficient in Microsoft Excel and/or Google Sheets
• Independent, critical thinker with meticulous attention to detail

Why you should join our team

By joining Pomelo, you will get in on the ground floor of a fast-moving, well-funded, and mission-driven startup where you will have a profound impact on the patients we serve. And you'll learn, grow, be challenged, and have fun with your team while doing it.

We strive to create an environment where employees from all backgrounds are respected. We value working across disciplines, moving fast, data-driven decision making, learning, and always putting the patient first.

At Pomelo, we are committed to hiring the best team to improve outcomes for all mothers and babies, regardless of their background. We need diverse perspectives to reflect the diversity of problems we face and the population we serve. We look to hire people from a variety of backgrounds, including but not limited to race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.

Our salary ranges are based on paying competitively for our company’s size and industry, and are one part of the total compensation package that also includes equity, benefits, and other opportunities at Pomelo Care. In accordance with New York City, Colorado, California, and other applicable laws, Pomelo Care is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including qualifications for the role, experience level, skillset, geography, and balancing internal equity. A reasonable estimate of the current hourly range is $20-$25 per hour. We expect most candidates to fall in the middle of the range. We also believe that your personal needs and preferences should be taken into consideration, so we allow some choice between equity and cash.