Rheumatology Medical Coder

About Brixa Health

Brixa Health is a startup in Massachusetts. We take rheumatology billing off the people in the practice so clinicians and office staff can spend more time with their patients. That means catching denials earlier, routing them to the right person, and getting the appeal out with the right documentation the first time. Rheumatology has its own problem (biologics, buy-and-bill, step therapy, same-day E/M and injections) and general-purpose tools don’t handle it well. We’re three founders, we’re early, and we’d rather build this with a coder in the room than guess.

The role

We’re looking for an experienced rheumatology coder to be the person who tells us when we’re wrong, and a thought partner as we build. You’ll work directly with the founders initially to review and pressure-test the denial logic in our product, help research and build out our rule library and appeal templates, and shape how the tool behaves for the customers who’ll actually use it.

The first step after a short interview is a paid working session where we walk through 20–30 real denial scenarios together and you tell us what we got right, what we got wrong, and what we don’t know that we should.

What you’ll actually do

• Review denial scenarios and our proposed handling of them, and document where the logic breaks.
• Help build and maintain a rheumatology-specific rule library: which denials are appealable, which are corrections, which are lost causes, and why.
• Write and refine appeal templates for common biologic, infusion, and E/M denials.
• Map prior authorization and step-therapy workflows as they actually happen in a practice, not as the payer describes them.
• Flag payer-specific behavior you’ve seen in the wild that we’d never find in a policy document.
• Test the software as it develops and be blunt about what would make a biller stop using it or use it more.

Must have

• Rheumatology experience, one of two ways: at least five years of hands-on rheumatology coding and billing, or a current CRHC (Certified Rheumatology Coder, AAPC) in good standing with at least two years of hands-on rheumatology coding and billing. General specialty experience won’t translate here.
• Direct, recent experience with denials and appeals, including biologic and infusion drug denials.
• Deep familiarity with biologic coding: HCPCS J-codes, units and NDC reporting, JW and JZ modifiers, wastage, and infusion and injection administration codes, including the chemotherapy-administration series where payers require it.
• E/M with in-office procedures and same-day procedures: modifier 25, joint and soft-tissue injections (20600–20611), and the medical-necessity documentation payers push back on.
• Prior authorization as a working process, not just a form: step therapy, site-of-care requirements, re-authorization timing, and what happens when the auth and the claim don’t match.
• Comfort reading 835 remittances and knowing what a CARC/RARC pair actually means in practice for a given payer.

Nice to have

• CPC, CPB, or CPMA, and the CRHC if you don’t already hold it.
• Experience billing for a standalone or hospital-based infusion center.
• Time in a practice-management or EHR system commonly used in rheumatology (eClinicalWorks, athenahealth, NextGen, ModMed, or similar).
• Comfortable in Excel, and comfortable giving direct feedback to people who are building software and don’t share your background.
• You’ve worked somewhere small before, or you want to.

Compensation and hours

$65 to $90 per hour depending on experience. The initial working session after the interview is a flat $200 for 90 minutes. Hours are flexible and can include evenings; most of the work is remote, with occasional in-person sessions in the Boston area as needed.

How to apply

Email f.leffler@brixahealth.com with the subject line “Rheum Coder.” Include a resume and a few sentences on your rheumatology billing background. If you want to stand out, tell us about one denial you overturned that you’re proud of and how you did it. No PHI, please.

We’ll reply to everyone who meets the experience requirement within a few business days.

Brixa Health is an equal opportunity employer. We make hiring decisions on the basis of qualifications and experience without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected characteristic.