Sr. Billing Representative, Remote



Hialeah, FL, USA
Posted on Tuesday, June 6, 2023
Aledade is a leader in population health that is using innovative, value based solutions to transform the way physicians interact with their patients. We are on a mission to change healthcare for the better and solve complex problems within the healthcare system.
We are searching for a Sr. Billing Representative to join the team. This person in this role is integral to the revenue cycle management team. This position supports several revenue cycle functions, including insurance verification and eligibility, timely claims submission, and denial management. The Billing Representative is the subject matter expert for compliant claims submission, payer policies, and governmental regulations.


  • Electronic claims submission according to payer contracts, governmental and/or third-party guidelines
  • 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
  • Adhere to productivity standards using key performance indicators (KPIs) and established healthcare billing metrics
  • Collaborate with the coding team to overturn coding-related denials
  • Collaborate with the RCM teams to ensure effective resubmission of special projects
  • Identify and alert leadership of denial trends and make recommendations for front-end edits to minimize reimbursement delays
  • Provide education and accurate answers to billing-related questions in a timely manner
  • Serve as a super-user for multiple practice management systems
  • Assists in process mapping and the development of workflows for best practices in medical billing
  • Report data inconsistencies to leadership
  • Participate in regular team meetings, peer review activities, and departmental and organizational work groups as applicable
  • Performs all job functions in compliance with applicable federal, state, and local laws and organizational policies and procedures
  • Other duties as assigned

Performance Requirements, Skills, and Abilities:

  • Understanding 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
  • Expertise in applying payer policy, Local Coverage Determinations, National Coverage determinations, and National Correct Coding Initiatives
  • 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 interpersonal and organizational skills
  • Effective oral and written communication skills with audience adaptability
  • Ability to work independently
  • 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

Required Certifications, Education, and Experience:

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