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.  

• 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 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.