The Dental Billing Specialist reviews electronic dental records, computer generated reports, and other reporting tools to identify conditions treated and the services provided to each patient. This role is responsible for overseeing the timely and accurate coding of diagnoses, services and procedures performed by dentists, hygienists, and any other provider performing billable services, and supplies used utilizing the appropriate coding system. Excellent customer service and communication skills are required for this position. Spanish bilingual is a plus. This position also monitors and resolves all aged receivables. The Dental Billing Specialist contributes to a work environment that is innovative, caring and collaborative and supports the mission and vision of CHP and compliance protocols.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
• Reviews EDR billing system, computer generated reports and other reporting tools to identify all services and procedures performed by providers, and any other provider performing billable services.
• Reviews encounter forms to ensure appropriate diagnosis codes selecting the codes that accurately describe the condition for which the service or procedure was performed.
• Prepares accurate claims for timely submission to the appropriate third party payers.
• Posts third party payments received to appropriate patient accounts, files Explanation of Benefits (EOB) according to clinic procedure.
• Works cooperatively with third party payers to reconcile payments in a timely manner.
• Ensures that dental staff complies with various third party rules and regulations.
• Analyzes and investigates all third party claims that become 60 days past due to determine cause. Distributes overdue/denied claims and reports to dental, fiscal and administrative leadership.
• Collaborates with practice mangers to monitor, review and track all correspondence from insurers regarding claims.
• Investigates all denied claims, corrects any coding errors and resubmits the claims for payment.
• Assists with provider billing and documentation training as needed.
• Maintains all payer training manuals; notifies dental staff of any change in any insurer’s rules and regulations.
• With the billing team follows and reports status of delinquent accounts and works to collect aged balances.
• With the billing team evaluate patient financial status and establish payment plans as instructed.
• Applies payments accounts received through bank deposits and insurance carriers.
• Prepares and mails statements to patients with unpaid balances.
• Answers patient questions, identifies and resolves patient billing complaints.
• Ability to interact with others with tact and diplomacy; treat others with respect and consideration regardless of status or position; contribute to a positive team spirit; balance team and individual responsibilities; display highest degree of professionalism and ethics.
• Respond appropriately to patient needs; manage difficult or emotional patient situations in a way that instills trust and respect; solicit feedback to improve performance.
• Ability to manage multiple priorities; work well under pressure; complete tasks correctly and on time with limited supervision; step in when needed and cross train for additional site coverage; respond promptly to requests for service and assistance; confidence in leading and instructing others; ability to delegate effectively
• Ability to effectively present information in one-on-one or small group situations; respond well to questions; complete administrative duties accurately and timely.
• Ability to calculate figures and amounts; solve practical problems; interpret a variety of instructions furnished in written, oral, diagram or schedule form.
• Punctual and reliable; ability to maintain schedule commitments.
• Spanish speaking/bilingual is a plus.
• Knowledge of dental terminology, anatomy and physiology; knowledge of CDT and modifier usage; knowledge of third party payer reimbursement policies and procedures; knowledge of coding and billing programs and ability to use coding and claims software; knowledge of Electronic Dental Record system preferred.