GENERAL DESCRIPTION:
The Dental Billing Specialist will perform advanced work to bridge the gap between dental providers, patients, and the insurance companies by making sure the correct information is updated and added to the electronic medical record before transmitting claims. This individual will ensure timely and accurate reimbursements by batching, reviewing, and correcting any internal claim errors before submission to the electronic billing clearinghouse. Upon claim submission to the proper clearinghouse, the biller will review the uploaded claims to correct any front-end edits that could prevent the claim reimbursements.
While overseeing the dental billing process, the Dental Billing Specialist is also responsible for posting (and recording) claim payments received, following up on non-paid claims to correct for reimbursement in a timely manner and processing any corrected and/or VOID claims. The Dental Billing Specialist should understand how to manage patient information in accordance with HIPAA regulations, know how to locate and understand provider manuals.
EDUCATION AND EXPERIENCE:
- High school diploma or equivalent required
- A minimum of four (4) years of advanced dental claims processing experience is required.
- Knowledge of dental health, professional and facility claims processing, payment, and denial resolution as well as diverse insurance background preferred.
- Dental billing or coding certification preferred.
- Demonstrated knowledge of the patient scheduling and registration process.
- Demonstrated knowledge of ICD, HCPC and CPT coding methodologies.
- Demonstrated knowledge of CMS, Third Party Payers, and Managed Care Guidelines
- Knowledge of dental x-rays, dental terminology, and the dental authorization process as well as a diverse insurance background required.
- Experience with reviewing authorization requests for pediatric and adult dental x-rays required.
- Problem solving and research skills; analytical, communications and critical thinking skills.
- Working knowledge of FQHC and Community Dental Health claims.
