Billing Specialist

Zarminali Pediatrics is building the nation's leading pediatric multispecialty group, focused on supporting families to shape healthy futures for their children – from birth through adulthood – by completely transforming the way pediatric care is delivered nationwide. We are tackling today's challenges of increased administrative burden on clinicians and a siloed approach to pediatric care through intentional design of care delivery, enhanced by leading technology and collaborative, expert care teams. Our name, inspired by our founder's daughter's name – Zarmina – means “something that is more precious to you than gold”. We couldn’t think of anything that better represents the way parents and caregivers hold the relationship with their children as the most valuable gift, and how we at Zarminali approach care for each child with equal reverence. We strive for a healthier future for pediatric patients and a happier future for pediatric clinicians nationwide, and we are looking for people to join us in achieving this vision. If you are eager to join a growth stage company and be part of the early team that is shaping the foundation of both the company and the delivery of pediatric care, then this opportunity might be for you! POSITION OVERVIEW The Billing Specialist plays a critical role in ensuring accurate claim processing, timely reimbursement, and effective accounts receivable management across Zarminali Pediatrics’ multi-state clinical footprint. This position requires advanced knowledge of pediatric billing, Medicaid managed care rules, payer policies, and coding accuracy. You will be responsible for moving claims efficiently through the revenue cycle by proactively identifying issues, resolving denials, monitoring payer activity, and coordinating with billing, coding, credentialing, and clinical teams. High accuracy, strong analytical skills, and consistent follow-through are essential to success in this role. WHAT YOU'LL DO: Claims Processing & Submission Prepare, review, and submit claims through Athena and clearinghouse Verify accuracy of demographics, insurance coverage, charge details, coding, modifiers, and Monitor and resolve claim edits, clearinghouse rejections, and payer error reports with same-day or next-day turnaround. Accounts Receivable & Follow-Up Perform daily AR follow-up on outstanding claims across Medicaid, managed Medicaid, commercial plans, and third-party administrators. Investigate and resolve payer issues including eligibility conflicts, COB problems, primary/secondary discrepancies, and refund requirements. Review payments, adjustments, and write-offs; identify underpayments and initiate payer follow-up as needed. Denial Management & Resolution Conduct root-cause analysis for claim denials and rejections. Correct coding, demographic, or payer-sequencing issues and submit corrected Prepare appeals, reconsiderations, and supporting documentation when Collaborate with coding, credentialing, and revenue cycle leadership to address recurring denial trends or workflow gaps. Patient Billing Support Handle patient statements, payment plan setup, and explanation of benefits Resolve patient billing inquiries with professionalism, clarity, and Reporting & Compliance Contribute to month-end close processes including AR status updates, denial trend summaries, and backlog reporting. Ensure full compliance with payer rules, Medicaid regulations, documentation standards, and organizational billing policies. Other Duties as assigned WHAT YOU'LL NEED: 3+ years of medical billing and AR experience; pediatric or multi-specialty experience strongly Strong understanding of CPT, ICD-10, HCPCS, NCCI edits, and proper modifier usage—especially for pediatrics, vaccines, behavioral health, and therapy services. Deep knowledge of Medicaid and managed Medicaid billing requirements, denial codes, filing timelines, and documentation prerequisites. Experience working in Athena EMR / AthenaOne, particularly charge review worklists, claim edits, encounter status, and payer configurations. Excellent problem-solving skills with the ability to resolve complex billing issues Strong written and verbal communication skills for interacting with patients, payers, and internal Ability to manage multiple priorities, meet deadlines, and maintain accuracy in a high-volume Experience supporting multi-state pediatric practices or high-volume specialty Familiarity with credentialing workflows and how credentialing issues affect WHAT WE OFFER: The opportunity to play an essential role in supporting high-quality pediatric care across multiple A collaborative environment working alongside billing, coding, clinical, and revenue cycle Professional development opportunities in pediatric billing, AR management, and revenue cycle Competitive compensation, comprehensive benefits, and opportunities for advancement within a growing A mission-driven culture dedicated to improving the healthcare experience for children and families At Zarminali Pediatrics, we are committed to our empowering clinicians and team members to deliver better pediatric care, altogether. This commitment requires building an inclusive culture and a team that represents the diverse communities we serve. We believe that when people from all backgrounds, experiences, and perspectives come together, we create a stronger team and better care for our patients and their families. We realize the importance of an environment where clinicians and team members feel cared for, supported, and valued. We believe in the basics: treating everyone with kindness, respect, and fairness. We do not tolerate discrimination or harassment of any kind. This includes, but is not limited to, race, color, sex, gender, age, religion or religious creed, national origin, ancestry, citizenship, marital status, sexual orientation, gender identity, gender expression, genetic information, physical or mental disability, military or veteran status, or any other characteristic protected by law. We recruit and hire based on skills, talent, and potential, ensuring everyone has a fair chance to succeed. Together, we strive to build an inclusive and welcoming space where we can achieve our goal of building a happier future for the pediatric workforce.