Certified Biller/Coder Specialist

Avenue 360 Health and Wellness•Houston, TX

3d•Hybrid

About The Position

The Hybrid Certified Biller or Coding Specialist is responsible for the accurate and timely billing of all payer types, including commercial insurance, Medicare, Medicaid, self-pay, and grant-funded programs. This position ensures coding accuracy, regulatory compliance, and optimal reimbursement through claim submission, coding validation, billing audits, denial management, provider education, and documentation improvement. The specialist serves as a revenue cycle resource by identifying billing and coding trends, providing provider feedback, and supporting continuous process improvement initiatives.

Requirements

High School Diploma or GED
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Biller (CPB), RHIT, RHIA, or equivalent certification through AAPC, AHIMA, or NHA.
If not certified upon hire, certification must be obtained within six (6) months of employment.
Minimum three (3) years of medical billing and/or coding experience.
Experience interpreting medical documentation and assigning ICD-10-CM, CPT, and HCPCS codes.
Experience resolving claim edits, denials, and payer rejections.
Knowledge of commercial, Medicare, Medicaid, and managed care billing requirements.
Experience working within an Electronic Health Record (Epic preferred).
Strong understanding of medical terminology, anatomy, and physiology.
Knowledge of federal and state billing regulations.
Excellent analytical and problem-solving skills.
Strong organizational and time management abilities.
Excellent written and verbal communication.
Ability to prioritize multiple assignments.
Ability to educate providers and clinical staff regarding coding and documentation.
Strong Microsoft Office skills including Excel, Word, Outlook, and PowerPoint.
Maintain all required certifications in good standing.
Complete all mandatory organizational education annually.
Participate in coding, compliance, payer, and regulatory updates.
Attend continuing education necessary to maintain professional certifications.

Nice To Haves

Experience in a Federally Qualified Health Center (FQHC).
Experience with Epic/OCHIN.
Experience with auditing and provider education.

Responsibilities

Submit and manage billing for commercial, Medicare, Medicaid, managed care, self-pay, and grant-funded programs.
Review claims for coding accuracy, billing compliance, and payer-specific requirements prior to submission.
Resolve billing edits, rejections, denials, and payment variances.
Perform coding and billing audits to evaluate documentation accuracy and compliance.
Issue provider queries to clarify or obtain additional documentation necessary for accurate code assignment.
Monitor denial and rejection trends and recommend corrective actions.
Provide coding and documentation education to providers and clinical staff.
Present revenue cycle metrics, billing trends, denial trends, and coding opportunities during Revenue Cycle meetings.
Support revenue integrity initiatives that improve clean claim rates and reduce avoidable denials.
Maintain compliance with CMS, Medicaid, Medicare, commercial payer, and FQHC billing regulations.
Collaborate with clinical, operations, finance, and revenue cycle leadership to improve reimbursement and documentation quality.