Dental Billing Specialist

JOB SUMMARY

The Billing Specialist is responsible for all aspects of dental claims. The Billing Specialist, a key position in the Revenue Cycle, facilitates the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries and patients. The incumbent will assist in the clarification and development of process improvements and inquiries to maximize revenues.

Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements for this job description are not intended to be all inclusive. They represent typical elements considered necessary to successfully perform the job.

REPORTING RELATIONSHIPS

The position reports to the Revenue Cycle Manager. No staff report to this position.  This position is required to be on-site.

JOB DUTIES AND ESSENTIAL FUNCTIONS

• Prepares and submits clean claims to third party payers electronically, or via the payer portal
• Follows dental billing guidelines and legal requirements to ensure compliance with federal and state regulations
• Respond to inquiries from patients, payers, providers, and/or other staff as requested
• Identifies and resolves patient/insurance billing issues
• Work closely with team members regarding claim appeals, denials, resolution, and education
• Performs and monitors all steps in the billing processes to ensure maximum reimbursement from patients, government, and commercial payers as well as from special billing arrangements
• Understands Medicare, Dental Medicaid and Commercial Dental Payer rules and regulations applicable to billing and coding. Updates business office staff, clinics, patients, and faculty of changes as appropriate
• Responsible for ensuring all new providers are oriented to coding, billing, and documentation compliance
• Responsible for the continuing billing and documentation education for all providers and residents
• Use online healthcare databases and other resources for verification and claim status
• Deliver the highest quality service to internal and external customers
• Assist other members of the team with projects as needed
• Maintains strict confidentiality; adheres to all HIPAA guidelines/regulations
• Other duties as assigned by management
• Adhere to the Mission and Values of MNHC

QUALIFICATIONS

• High School Diploma/GED
• Minimum 3 years dental billing experience
• Must have strong knowledge of all guidelines for ICD-10, CDT codes, dental terminology, dental procedures and dental billing processes
• Knowledge of Dental Billing/EHR (Electronic Health Records) systems preferably Epic
• Knowledge of Dental Reimbursements with knowledge of and EOBs, EFTs and ERAs
• Knowledge of Microsoft Office software
• Must be focused, self-directed, organized, and have demonstrated problem-solving abilities
• Accurate and precise attention to detail
• Excellent verbal and written communication skills
• Able to work both independently and as part of a team
• Must possess team leadership skills and have a positive disposition
• FQHC Dental Billing experience will be given special consideration

CERTIFICATIONS

• Certification in Dental Billing and Coding from AAPC
• ADA Dental Coding Certificate
• Membership in American Dental Coders Association preferred
  • Certified Dental Billing Specialist (CDBS) highly preferred
  • Certified Dental Coader (CDC) highly preferred

PHYSICAL DEMANDS: The physical demands described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodation will be provided to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand, walk, talk, and hear, use hands to finger, handle or feel. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee is frequently required to lift and/or move up to 20 pounds. The special vision requirements for this job are close vision (clear vision at 20 inches or less), color vision (ability to identify and distinguish colors).

WORK ENVIRONMENT: The work environmental characteristics described herein are representative of those an employee encounters while performing the essential functions for this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

MedNorth Health Center provides comprehensive health care services, inside a multi-cultural medical/dental clinic, to all individuals; insured, uninsured, and underinsured. The building is heated in winter and air conditioned in the summer with noise levels of moderate to loud. We serve patients who speak multiple languages and who may need the assistance of an interpreter. In this position one may be subject to exposure to copier toner, correction fluid, bright fluorescent lighting, and continuous personal computer exposure.

This job is a Blood borne Pathogen’s risk category I position.

GENERAL EXPECTATIONS:

• The employee is expected to attend work daily on-site and to be at work on time M-F 8am-5pm.
• The employee is expected to be a team player.
• The employee is expected to report absences in accordance with personnel policies and procedures.
• The employee’s work is expected to be accurate, neat, and thorough, and completed on time.
• The employee is expected to have a positive attitude, be cooperative, and be considerate of others.
• The employee is expected to be dependable and is expected to accept responsibility for assignments and duties given.
• The employee is expected to dress and act in a professional manner and to adhere to all safety standards.
• The employee is expected to participate in staff meetings, be courteous and polite with patients and other staff.

The employee is expected to maintain confidentiality.