Summary:

Reporting to the Direct Supervisor, the Dental Billing Specialist is responsible for the Billing and Fiscal related operations of the Dental program.

Essential Job Functions:

• Review all charges posting into Patients’ Ledgers to include ADA codes appropriate to each dental carrier.
• Provide second review prior to sending claims of eligibility status of patients to include running REVS, calling Managed Care Organizations and state organizations and reconciliation of enrollment from 3rd party payors such as PACE and SCO.
• Provide instruction to and review with Providers, Practice Manager, and Controller regarding any errors and omissions on a monthly basis related to charges posting to the Ledgers.
• Continue personal education on any billing practice changes as initiated by insurance carriers and/or state agencies.
• Make determination and provide reporting as to which carrier claims are sent providing a documented reconciliation of charges.
• Responsible for sending all claims to each carrier and/or patient whether it be via paper or electronic methods.

Qualifications:

• History of good attendance and positive work attitude.
• College degree or equivalent bookkeeping/billing experience.
• Computer proficiency.
• Knowledge of professional office practices.
• Must be comfortable in a medical/dental environment and able to maintain strict confidentiality.
• Excellent communication skills, professional demeanor, and good judgment.
• Prior experience in a dental or medical office is preferred.
• Understanding of Medicaid and Free Care health insurance plans is preferred.
• Bi-lingual in Spanish/Khmer and English preferred.

Duties and Responsibilities:

• Review all charges posting into Patients’ Ledgers to include ADA codes appropriate to each dental carrier.
• Provide second review prior to sending claims of eligibility status of patients to include running REVS, calling Managed Care Organizations and state organizations and reconciliation of enrollment from 3rd party payors such as PACE and SCO.
• Provide instruction to and review with Providers, Practice Manager, and Controller regarding any errors and omissions on a monthly basis related to charges posting to the Ledgers.
• Continued personal education on any billing practice changes as initiated by insurance carriers and/or state agencies.
• Make determination and provide reporting as to which carrier claims are sent providing a documented reconciliation of charges.
• Responsible for sending all claims to each carrier and/or patient whether it be via paper or electronic methods.
• Post all cash receipts from Self-Pay and insurance carriers.
• Tie out the cash receipts journal at the end of the month including a full explanation of any variance.
• Prepares monthly HSN, insurance, bad debt, suspended credit and refunds adjustments.
• Research all denials received, make appropriate corrections (if applicable), and resubmit within a timely manner.
• Properly complete follow up on all claims from the monthly un-paid claims report, returning the report to the Controller each month. Attached to the report should be a full accounting of the status of each claim and the action taken.
• Analyze and follow-up on unpaid claims to include recommendations for Bad Debt and other write offs.
• Responsible for analyzing the appropriateness of and subsequent posting of all entries in the Patients’ Accounts.
• Generation, review and submission of all month –end reports.
• Related duties as assigned: filing, scanninh, setting up financial plans with patients, gathering documentation requested for audits, assisting other staff when needed. Any special assignments as needed that pertain to the Fiscal department.
• Maintain patient confidentiality at all times.
• Perform additional, related duties as assigned by supervisor.
• Collects and analyses data as needed.
• Responsible for a weekly status report to the Direct Supervisor
• Individual must be able to work autonomously, conscientiously and proactively.