Description

The Revenue Cycle Specialist will be well versed and multiskilled in all areas of the revenue cycle. Must be comfortable working in a fast paced, high-volume environment, responsible for the revenue cycle processes of multisite Dental Service Organization(DSO).

Key Responsibilities: 

• Daily posting of insurance payments to practice management software to ensure appropriate billing, coding, and collections. 
• Responsible for all aspects of outstanding insurance claims follow up (every 14-21 days until properly adjudicated) 
• Rejected and denied claims follow reprocessing when applicable.
• Initiates appeal submissions and ensures all required documentation is submitted in the appeal process. 
• Identifies trends within claims management -communicating issues and resolution with leadership. 
• Identifies all exceptions both by offices and insurance verification team that leads to increasing AR -communicating with leadership.
• Identifies discrepancies in how claims are being paid according to fee schedule. 
• Patient account balance audits after all claims have been processed- documenting in patient charts & submitting billing statements. 
• Performs appropriate billing functions, manual resubmissions, e-claim submissions, and corrected claims in timely manner.
• Thorough understanding of credentialing both direct and indirect. 
• Thorough understanding of inclusive procedures (when to adjust and when to balance bill). 
• Thorough understanding and research of recoupments and how to accurately post to ledgers. 
• Reviewing patient accounts to determine and correct discrepancies, account audits, unapplied credits, aging AR, unposted payments. 
• Auditing for accuracy of account credits.
• Communicates with and supports assigned office admin with patient account inquires in timely manner.
• Other duties as assigned by leadership.

Requirements

• 2 years dental admin/ insurance background
• Dentrix Ascend knowledge preferred.
• Microsoft Office/Excel knowledge required.