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Aledade about 1 year ago
location: remoteus
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Sr. Billing Representative, Remote





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.

The Sr. Billing Representative is integral to the revenue cycle management team. This role 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 erse populations

Required Certifications, Education, and Experience

  • High School Diploma or GED
  • Bachelor’s degree in health-related services preferred
  • Certified Professional Coder (CPC), Certified Professional Biller (CPB), or related certification 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

All prospective hires will be required to demonstrate that they have been fully vaccinated, including booster shots, against COVID-19 with a COVID-19 vaccine for which the U.S. Food and Drug Administration has issued a license or an Emergency Use Authorization prior to mutually-agreed upon start date at Aledade, unless they qualify for a medical or religious accommodation to this vaccination requirement.

If you are passionate about transforming the healthcare system into one that best serves the needs of patients, doctors, and society, we’d love for you to join us!

Who We Are:

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 follow the simple but radical idea that Aledade only succeeds when our partner practices succeed. From our cutting-edge technology platform to practice transformation services, we provide physicians with everything they need to create and run an accountable care organization (ACO), revamping the way they practice and getting them back to where they should be: quarterbacking their patients’ health care!

Our customized solutions help clinicians in communities across America preserve their autonomy, deliver better care to their patients, reduce overall costs, and keep independent physician practices flourishing.

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 work with team members that bring a wide range of experiences, interests, backgrounds, beliefs, and achievements to their work, united by a shared passion for public health and a commitment to the Aledade mission.

We’ve recently been recognized as a Top Workplace by The Washington Post, Best Workplace in HealthCare & Biopharma, Top 100 Best Small & Medium Workplaces, Glassdoor Best Places to Work, a Best and Brightest Companies to Work for in the Nation, a Tech Tribune 10 Best Tech Startups in Maryland and Bethesda, Best Tech for Good, Best Workplaces for Millennials, Best Workplaces for Women, Best Workplaces for Parents, Top Workplaces USA, and a Healthcare Industry Top Workplace.

That’s because the things that matter to you also matter to us!

  • In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the needs of our full-time team-members:
  • Flexible work schedules and ability to work remotely available for many roles
  • Educational Assistant Program
  • Robust time off plan (21 days of PTO in your first year!)
  • Paid Volunteer Days
  • 11 paid holidays
  • 12 weeks paid Parental Leave for all new parents
  • 6 weeks paid sabbatical
  • Health, dental and vision insurance paid up to 80% for employees, dependents, and domestic partners
  • 401(k) with up to 4% match
  • Stock options
  • Monthly cell phone stipend
  • Jeans everyday workplace
  • Gender neutral bathrooms
  • And more!

At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop, and retain highly qualified iniduals representing the erse communities where we live and work. Aledade is committed to creating a erse 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.