Sr. Billing Representative, Remote

Responsibilities:

• 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 Risk Adjustment Coder (CRC), 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