Hybrid Biller/Coder Specialist - Revenue Cycle Expert

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

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.