Hybrid Medical Billing & Coding Specialist

Avenue 360 Health and Wellness; Houston (TX); Híbrido; USD 60.000 - 78.000; Jornada completa

Descripción de la vacante

Avenue360 Health And Wellness in Houston seeks a Hybrid Certified Biller or Coding Specialist to ensure accurate billing across payer types, including Medicare, Medicaid, and grant-funded programs. You will oversee coding validation, audits, and provider education to improve reimbursements.

The role requires at least 3 years of medical billing/coding experience, proficiency in ICD-10-CM, CPT, HCPCS, and Epic EHR, with strong analytical and communication skills.

Formación

• Minimum three 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).

Responsabilidades

• 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.

Conocimientos

Medical terminology

Anatomy & physiology

Analytical skills

Time management

Communication skills

Coding interpretation

Educación

High School Diploma or GED

CPC/CCS/CPB/RHIT/RHIA or equivalent certification

Herramientas

Epic EHR

Microsoft Office

Descripción del empleo

Avenue360 Health And Wellness in Houston seeks a Hybrid Certified Biller or Coding Specialist to ensure accurate billing across payer types, including Medicare, Medicaid, and grant-funded programs. You will oversee coding validation, audits, and provider education to improve reimbursements.

The role requires at least 3 years of medical billing/coding experience, proficiency in ICD-10-CM, CPT, HCPCS, and Epic EHR, with strong analytical and communication skills.