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SalaryAledade, 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
- Bachelor'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 - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents, and domestic partners Robust time off plan 21 days of PTO in your first year 2 Paid Volunteer Days & 11 paid holidays
12 weeks paid Parental Leave for all new parents
6 weeks paid sabbatical after 6 years of service
Educational Assistant Program & Clinical Employee Reimbursement Program
401(K) with up to 4% match
Stock options
And much more!
At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop, and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance, and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
Privacy Policy: By applying for this job, you agree to Aledade's Applicant Privacy Policy available at https://www.aledade.com/privacy-policy-applicants
