Under the auspices of the Director of Finance, the Dental Billing & Reimbursement Specialist will fulfill all insurance billing and reimbursement activities for the center and all its sites. Successful performance of job duties will directly impact health system goals to obtain appropriate reimbursement and compensation for services rendered by professional staff. The Dental Billing Specialist will ensure and maintain all records in compliance with HIPAA.

DUTIES AND RESPONSIBILITIES:

• Submit accurate and complete dental claims on a timely basis to all payers for dental services rendered by the Client, while complying with all regulations.
• Assist with setting up claim processing at any new Client locations.
• Assist with training staff on proper claim submission.
• Post insurance payments from the Explanation of Benefits (EOB) from all insurance plans as received.
• Reconcile all denied claims. Make appropriate corrections relating to coding, insurance eligibility, provider issues, etc. Resubmit all corrected claims to appropriate insurance plans.
• Report to Director of Finance all issues affecting appropriate payment of claims relating to specific insurance plans.
• Communicate with Insurance Plans regarding outstanding claims, provider issues, etc.
• Assist Director of Finance as needed in preparation of reports and analysis.
• Do other duties as assigned.

QUALIFICATIONS:

• A high school graduate with at least two years of college education.
• Two to four years experience performing dental billing procedures or working with dental insurance programs.
• Ability to operate a compute including internet for accessing insurance plan web portals.
• Well organized, friendly, courteous, adaptable, dependable and patient. Must have ability to work well under pressure and be an effective communicator.
• A high degree of maintaining confidentiality.
• Clerical experience with ability to compose letters, contact patients and other professional organizations by telephone in a manner representing the organization’s mission and goals.
• Have computer experience and general understanding in order to make appropriate account adjustments, demographic changes and general navigation through the practice management systems.
• Ability to compile account information and prepare reports as requested by other staff.
• Prerequisites for the position include a clean criminal background check.

PHYSICAL DEMANDS/WORKING CONDITIONS:

May occasionally become crowded. Requires, bending, sitting, and some light lifting. Must be able to tolerate irate or dissatisfied patients regarding account balances, etc. Prolonged exposure to computer screen. In some cases, may be required to maneuver boxes of approximately 10-15 pounds.

SUPERVISION RECEIVED

Director of Finance, Senior Management

SUPERVISION GIVEN

Students, Volunteers, or anyone assigned by the Director of Finance.

INTERPERSONAL CONTACTS:

Position requires some interaction with patients, families, social workers, physicians, mid-level providers, referral clerks, nursing staff, front office staff and others.

RESPONSIBILITY FOR CONFIDENTIAL MATTERS:

Position is exposed to confidential patient information, correspondence, and reports. All staff is expected to adhere to the Center's confidentiality policy as stated in the Policy and Procedure Manual.

EFFECT OF ERRORS

Errors could expose the Center to liability, embarrassment, and loss of revenue.