RagaAI Inc
Website:
raga.ai
Job details:
About UsRagaAI builds an AI-powered clinical operations platform purpose-built for allergy and immunology practices. We automate scheduling, patient intake, insurance verification, prior authorization, claims, denials, collections, and analytics — helping clinics reclaim hundreds of hours of staff time every month. We are live across multiple allergy practices nationwide and scaling rapidly.
The Role
We are looking for an experienced Medical Coder with deep expertise in allergy and immunology to join our team. You will play a critical role in ensuring coding accuracy across our platform, building and validating coding logic for our AI-driven claims and denials engine, and supporting clinic operations with expert-level knowledge of allergy-specific CPT, ICD-10, HCPCS, and modifier usage.
Responsibilities
- Assign and validate CPT, ICD-10-CM, and HCPCS codes for allergy and immunology services including allergy testing (skin prick, intradermal, patch), immunotherapy (subcutaneous, sublingual), spirometry/PFTs, and biologic administrations (buy-and-bill).
- Review and audit claims for proper modifier usage (Modifier 25, 59, 76, 77, 95) and compliance with LCD/NCD policies specific to allergy procedures.
- Build, test, and refine coding rules within our AI-powered denials prevention engine — translating payer-specific requirements into structured logic.
- Analyze denied claims (ERA data), identify root causes (coding errors, missing modifiers, LCD non-compliance, NDC mismatches), and recommend corrective actions.
- Call insurance payers to verify benefits, eligibility, authorization requirements, claim status, denial reasons, and reimbursement details, and accurately document payer interactions.
- Collaborate with engineering and product teams to codify allergy-specific billing rules, payer quirks, and coding edge cases into the platform.
- Stay current on CPT annual updates, CMS policy changes, and payer-specific coding guidelines relevant to allergy and immunology.
- Support onboarding of new clinic customers by auditing their existing coding practices and identifying revenue leakage opportunities.
- Provide coding guidance on biologic drug administrations — including J-codes, NDC-to-HCPCS crosswalks, waste modifiers (JW/JZ), and units-of-service calculations.
Requirements
- CPC, CCS, or equivalent coding certification (AAPC or AHIMA).
- Minimum 1 year(s) of medical coding experience with a significant focus on allergy and immunology (outpatient/physician practice setting preferred).
- Strong working knowledge of allergy-specific CPT codes (95004, 95017, 95024, 95115, 95117, 95165, 95180, 96372, 96401, 96413, etc.) and associated ICD-10 codes.
- Experience with biologic drug coding — buy-and-bill J-codes (e.g., J0881 Dupilumab, J2182 Mepolizumab, J3490/J3590 miscellaneous), NDC documentation, and waste reporting.
- Familiarity with eClinicalWorks (ECW) billing workflows is a strong plus.
- Experience reading and interpreting EOBs, ERAs, and remittance advice.
- Strong knowledge of insurance verification, payer policies, eligibility, prior authorization, claims adjudication, denials, and reimbursement processes for Medicare, Medicaid, and commercial payers.
- Experience in calling insurance payers is mandatory.
- Knowledge of Medicare, Medicaid, and commercial payer reimbursement rules for allergy services.
- Comfortable working in a fast-paced, technology-driven environment alongside engineers and product managers.
Nice to Have
- Experience with denial management and appeals processes in allergy/immunology.
- Familiarity with Waystar, or other clearinghouse/EDI platforms.
- Background in auditing or compliance for specialty practices.
- Experience with data analysis tools (Excel, BigQuery, or similar) to support coding analytics.
Compensation & Benefits
Competitive salary commensurate with experience. Remote-first culture with flexible hours. Opportunity to shape coding intelligence at a fast-growing health-tech company building the future of allergy practice operations.
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