Certified Biller/Coder Specialist

Avenue360 Health and Wellness; Houston (TX); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Avenue360 Health and Wellness in Houston, TX seeks a Hybrid Certified Biller/Coder Specialist to ensure accurate billing across commercial, Medicare, Medicaid, and grant-funded programs. You will validate coding, support audits, and address denials while educating providers and staff.

Responsibilities include monitoring trends, collaborating with departments, and driving compliance with payer rules and CMS regulations to optimize reimbursements and documentation quality.

Qualifications

• High School Diploma or GED required.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Biller (CPB), RHIT, RHIA, or equivalent certification through AAPC/AHIMA/NHA.
• If not certified upon hire, certification must be obtained within six (6) months of employment.

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 obtain necessary documentation 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 and coding opportunities during Revenue Cycle meetings.
• Support revenue integrity initiatives to improve clean claim rates and reduce denials.
• Maintain CMS/Medicare/Medicaid/commercial payer billing regulations compliance.

Skills

Medical terminology

Anatomy & physiology

Billing regulations

Analytical skills

Time management

Provider education

Excel

Word

Outlook

PowerPoint

Education

High School Diploma or GED

CPC

CCS

CPB

RHIT

RHIA

Equivalent certification (AAPC/AHIMA/NHA)

Tools

Epic

OCHIN

Job description

Certified Biller/Coder Specialist

Avenue360 Health and Wellness Houston, Texas, United States

About this position

About Avenue360 Health and Wellness

Avenue 360 is a FQHC that strives to provide high quality and caring service to promote healthy people and communities. Our 360-degree approach addresses medical needs and social and environmental challenges, like housing. Our compassionate care extends to those with and without insurance. We believe income must not determine the level of access to quality health care.

Providing comprehensive, high quality, and caring service is the core of what we do, whether medical, hospice care, engaging adult activities, and supportive housing programs. We strive to address the many social determinants of healthy living in Greater Houston.

Our Values PACT

• We take PRIDE in our work.
• We have a positive ATTITUDE.
• We are CURIOUS.
• We are COMMITTED.
• We are CARING and CUSTOMER-SERVICE oriented.
• We are a TEAM.
• We LEARN, GROW, and INNOVATE

Role Overview

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.

Areas of Accountability

• 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. position is directly accountable for the following key areas:

Education, Licensure/Certification:

• 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.

Experience, Skills/Abilities Related Requirements:

Required Experience

• 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).

Skills

• 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.
• Ability to prioritize multiple assignments.
• Ability to educate providers and clinical staff regarding coding and documentation.
• Strong Microsoft Office skills including Exc
• el, Word, Outlook, and PowerPoint.

Preferred

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

Continuing Education and Training Requirements:

• 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.