Director of Reimbursement Research & Coding Strategy- Mom & Baby at Aeroflow Health

United States

<p><strong>Aeroflow Health &ndash; Mom and Baby Director of Reimbursement Research &amp; Coding Strategy</strong></p> <p><strong>Location - Remote with some travel to Asheville NC - Roughly once a month for 3-4 days.&nbsp;</strong></p> <p>Aeroflow Health is a leading provider of home medical equipment and clinical support services, helping patients across the country access the products and care they need to live healthier lives at home. Through innovative technology, streamlined delivery platforms, and deep expertise in insurance navigation, we remove barriers to care and simplify complex healthcare processes for families, providers, and payers alike.</p> <p>We are equally as passionate about taking care of our employees. Recognized as one of the fastest-growing healthcare companies in the U.S., an Inc. 5000 honoree, and a certified Great Place to Work&reg;, Aeroflow continues to seek ways they can be one of the nation&rsquo;s top employers.&nbsp; As we continue to grow, we remain committed to building an exceptional workplace where talented professionals are empowered, supported, and inspired to make meaningful impact every day.</p> <p><strong>The Opportunity</strong></p> <p>Aeroflow Health is seeking a Director of Reimbursement Research &amp; Coding Strategy to serve as the enterprise&rsquo;s subject-matter expert in medical billing, coding, payer policy, and reimbursement strategy across maternal health, telehealth, and evolving clinical service lines.</p> <p>This role is not operational billing management&mdash;rather, it is the strategic engine ensuring Aeroflow codes, documents, bills, and delivers clinical services in a way that is:</p> <ul> <li>Compliant with federal and state regulations</li> <li>Aligned to payer-specific rules and provider requirements</li> <li>Optimized for accurate reimbursement and financial sustainability</li> <li>Scalable as Aeroflow expands into new services and provider types</li> </ul> <p>This leader will partner closely with payer relations, clinical leaders, compliance, and business unit operators to research, interpret, and translate payer rules into actionable billing and coding guidance.</p> <p>Examples of supported areas include:</p> <ul> <li>Lactation classes and clinical lactation services</li> <li>CHW care coordination programs</li> <li>Nutrition &amp; perinatal education programs</li> <li>Doula and birth support services</li> <li>Telehealth medical visits and remote patient monitoring</li> <li>New clinical services added across Aeroflow business units</li> </ul> <p><strong>Your Primary Responsibilities</strong></p> <p>We are currently seeking a <strong>Director of Reimbursement Research &amp; Coding Strategy </strong>to:</p> <ul> <li>Serve as Aeroflow&rsquo;s enterprise expert on federal, state, and commercial reimbursement rules across telehealth, maternal health, DME-adjacent services, and emerging care models.</li> <li>Research and interpret coverage policies, billing rules, provider qualifications, supervision requirements, and documentation standards.</li> <li>Evaluate new service offerings for reimbursement viability, including coding pathways, provider credentialing needs, and payer-specific limitations.</li> <li>Maintain deep knowledge of CPT, HCPCS, ICD-10, and emerging codes relevant to maternal, perinatal, and education services.</li> <li>Develop and maintain a centralized coding strategy for classes, clinical services, virtual care, and hybrid product + service models.</li> <li>Ensure Aeroflow uses the correct codes, billing modifiers, place-of-service designations, and documentation requirements for each service type.</li> <li>Identify gaps or inconsistencies in billing and coding and recommend corrections.</li> <li>Assess provider types required for billable services (e.g., IBCLC, MD, NP, PA, PT, CHW, doula) and ensure alignment to payer rules.</li> <li>Work closely with the Payer Relations team to align internal billing methodology with contract terms and coverage decisions.</li> <li>Collaborate with clinical leaders to ensure documentation templates support compliant billing.</li> <li>Advise Product &amp; Technology teams on documentation capture, coding logic, and workflow automation opportunities.</li> <li>Partner with Compliance to prepare for audits and ensure regulatory adherence.</li> <li>Build playbooks, coverage matrices, SOPs, and educational materials that translate payer rules into clear operational guidance.</li> <li>Serve as the escalation point for coding questions, new benefit review, and payer interpretation issues.</li> <li>Employee has an individual responsibility for knowledge of and compliance with laws, regulations, and policies.</li> <li>Compliance is a condition of employment and is considered an element of job performance</li> <li>Maintain HIPAA/patient confidentiality</li> <li>Regular and reliable attendance as assigned by your schedule</li> <li>Other job duties assigned</li> </ul> <p><strong>Skills for Success</strong></p> <ul> <li>Regulatory &amp; Policy Expert: Deep understanding of how payer rules, state Medicaid programs, and CMS guidelines drive billing strategy.</li> <li>Analytical Researcher: Ability to break down complex reimbursement policies into actionable guidance.</li> <li>Healthcare Coding Strategist: Strong command of telehealth, maternal health, PT/OT, CHW, and education-service coding frameworks.</li> <li>Cross-Functional Influencer: Able to guide diverse teams (clinical, payer relations, compliance, product) toward aligned solutions.</li> <li>Operational Translator: Skilled at converting regulatory language into practical processes and documentation standards.</li> <li>Adaptive Leader: Thrives in a high-growth environment with evolving services and state-by-state policy nuances.</li> </ul> <p><strong>Required Qualifications</strong></p> <ul> <li>8+ years of experience in medical reimbursement, payer policy analysis, provider coding, or regulatory research.</li> <li>Demonstrated expertise in CPT/HCPCS/ICD-10 coding and payer policy interpretation.</li> <li>Experience with telehealth, maternal health services, or multi-state reimbursement environments.</li> <li>Strong understanding of Medicare, Medicaid, and commercial coverage policies.</li> <li>Experience evaluating reimbursement feasibility for new clinical or educational services.</li> <li>Advanced skills synthesizing policy, coding, and compliance into recommendations for senior leadership.</li> </ul> <p><strong>You might also have</strong></p> <ul> <li>Coding certifications such as CPC, CPB, CCS, CRC, or similar.</li> <li>Experience with perinatal or women's health services (e.g., lactation, doula, CHW, PT).</li> <li>Familiarity with payer negotiations or working alongside payer relations teams.</li> <li>Experience with virtual care delivery and hybrid clinical + product models.</li> <li>Background supporting multi-service, multi-state healthcare organizations.</li> <li>Working knowledge of documentation workflows, EHR systems, and billing logic automation.</li> </ul> <p><strong>What Aeroflow Offers</strong></p> <p>Competitive Pay, Health Plans with FSA or HSA options, Dental, and Vision Insurance, Optional Life Insurance, 401K with Company Match, 12 weeks of parental leave for birthing parent/ 4 weeks leave for non-birthing parent(s), Additional Parental benefits to include fertility stipends, free diapers, breast pump, Paid Holidays, PTO Accrual from day one, Employee Assistance Programs and SO MUCH MORE!!</p> <p>Here at Aeroflow, we are proud of our commitment to all of our employees. Aeroflow Health has been recognized both locally and nationally for the following achievements:</p> <ul> <li><strong></strong><strong> &nbsp; <span>&nbsp;</span></strong><strong>Family Forward Certified</strong></li> <li><strong></strong><strong> &nbsp; <span>&nbsp;</span></strong><strong>Great Place to Work Certified</strong></li> <li><strong></strong><strong> &nbsp; <span>&nbsp;</span></strong><strong>Inc. 5000 Best Place to Work award winner</strong></li> <li><strong></strong><strong> &nbsp; <span>&nbsp;</span></strong><strong>HME Excellence Award</strong></li> <li><strong></strong><strong> &nbsp; <span>&nbsp;</span></strong><strong>Sky High Growth Award</strong></li> </ul> <p>If you&rsquo;ve been looking for an opportunity that will allow you to make an impact, and an organization with unlimited growth potential, we want to hear from you!</p> <p>Aeroflow Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.</p> <p><em>&nbsp;</em><em>We value transparency and candidate safety throughout the hiring process. Aeroflow recruiters may reach out through platforms such as LinkedIn or Indeed; however, all interviews and/or offer coordination and sensitive information requests will occur only through our official communication channels. You will never be asked to provide personal data outside our secure application portal, and all interview or offer details will come from an @aeroflowinc.com email address. We do not conduct interviews via text message or instant-messaging apps. If you have concerns, please contact our Talent Acquisition team for verification</em></p>