The Clinical Finance Office seeks a Dental Financial Coordinator to oversee the workflow of dental clinical finances related to state Medicaid/Medicare programs, including MassHealth and other identified programs administered by Dentaquest and Skygen/Scion. The incumbent will assist the Billing and Claims Manager with effectively managing the BUGSDM Accounts Receivable, in particular items billed to MassHealth and other state Medicaid programs. This position requires processing of claims and pre-authorizations on a daily basis from GSDM to the plan administrator(s), i.e. Masshealth/Dentaquest. This will include a detailed review of the claims prior to submission for completeness and accuracy, as well as proactively investigating and resolving issues related to incorrect or missing patient information, treatment information, etc.

This position is responsible to review and investigate denials from the Medicaid/MassHealth administrator(s), i.e. Dentaquest, resubmit claims, processing adjustments to accounts within system, including write-offs and billing to the patients, as appropriate. In addition, provide reporting on denials to the Manager and Senior Manager, i.e. frequency of denial reason, departments with recurring issues, etc. Proactively investigate and resolve denials, including making recommendations to the Manager and Senior Manager as needed. This position is also responsible to accurately process/post accurately received payment to the applicable patients accounts. In addition, assist the Manager and Senior Manager by providing reporting regarding payments received, including a balancing of postings to the system versus remittance advices. In addition, they will assist the Manager and Senior Manager on all financial functions within the Office of Clinical Finance.