Sr. Billing Representative, Remote

Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care.
We are searching for Sr. Billing Representatives to join the team. These team members are integral to the revenue cycle management team, acting as the subject matter experts for compliant claims submission, payer policies, and governmental regulations. This role aids several revenue cycle functions, accurate coding, timely claim submission, and denial management. 

Essential Duties & Responsibilities:

• Conduct coding related pre-visit planning, post visit chart audits prior to claim submission, and query providers for identified discrepancies between claim documentation, ICD-10, and CPT Category I and II codes
• Timely follow-up on claim denials, submission of corrected claims and written appeals, ongoing follow-up of appeal submissions
• Utilize the accounts receivable aging report to resolve outstanding AR
• Electronic claims submission according to payer contracts, governmental and/or third-party guidelines
• Identify and alert management of denial trends and make recommendations for front-end edits to minimize reimbursement delays
• Report data inconsistencies to management, Participate in regular team meetings, peer review activities, and departmental and organizational work groups as applicable
• Adhere to productivity standards using key performance indicators (KPIs) and established healthcare billing metrics
• Performs all job functions in compliance with applicable federal, state, and local laws and organizational policies and procedures
• Other duties as assigned

Required Skills/Abilities:

• Comprehension of various types of insurance plans
• Adaptability to perform in various electronic health records (EHRs) and practice management systems
• Expert knowledge of risk coding in an Accountable Care Organization (ACO)
• Expertise in applying payer policy, Local Coverage Determinations (LCDs), National Coverage determinations (NCDs), and National Correct Coding Initiatives (NCCIs)
• Knowledge of CPT, ICD-10, and HCPC Level II coding guidelines
• Ability to navigate healthcare industry rules and regulations, including HIPAA, False Claims Act, Fair Debt Collections Act, and Stark Law
• Excellent collaboration and organizational skills
• Effective oral and written communication skills with audience adaptability
• Ability to work autonomously
• Establish and maintain effective working relationships with partner practices, insurance payers, EHR vendors, internal Aledade stakeholders, and co-workers
• Ability to use good judgment and critical thinking skills; ability to identify and resolve problems promptly
• Ability to work with diverse populations

Education & Experience:

• High School Diploma or GED required
• bachellor's degree in health-related services preferred
• Minimum 10 years’ experience of billing and coding experience in an outpatient physician practice, ambulatory care setting, or other health-related enterprise, with solid comprehension of coding guidelines.
• Certified Professional Coder (CPC) required, Certified Risk Adjustment (CRC) nice to have

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer

Who We Are:Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of payers, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives, and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
What Does This Mean for You?At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work