The Dental Billing Specialist is responsible for ensuring accurate dental coding, creating and submitting claims to insurance companies, and billing of patients’ accounts receivable in an accurate and timely manner. He/she assists patients with financial concerns related to insurance and billing and assists with development and maintenance of the coding process and internal controls.
- Follow policies and procedures to ensure efficient and timely operations of the finance department in order to maximize collection of both insurance and patient payments.
- Process dental primary and secondary insurance claims and prior authorizations in a timely manner.
- Provide necessary information to patients and insurance companies to resolve insurance or statement questions, reimbursements, or refunds.
- Keep updated and maintain working knowledge of dental coding and apply knowledge to ensure charges are appropriate for services rendered.
- Review update to coding rules/guidelines; educate staff as appropriate and in a timely manner.
- Accurately post dental insurance checks and adjustments against claims and bill patients for indicated balances on their account.
- Correct and re-file any denied, suspended or partially paid claims.
- Create, mail and maintain regular statement cycles according to ODHC’s Financial Policies and Procedures.
- Ensure appropriate sliding fee discounts are applied to patient account balances before billing the patient and/or mailing billing statements.
- Handle returned statements; flag incorrect patient mailing addresses in the practice management software and in patient charts.
- Read communication from insurance carriers and update the supervisor on any urgent issues regarding insurance claims processing.
- Actively pursue an understanding of insurance carrier(s) and their policies as related to services we provide and to Federally Qualified Health Center specific billing.
- Actively trouble shoot and resolve escalated coding issues through appropriate means and in accordance with Open Door Health Clinic (ODHC) policies and procedures.
- Demonstrate a knowledge and understanding of how to access web-sites applicable to insurance carrier(s).
- Accurately post dental insurance checks and adjustments against claims and bill the patient for indicated balances on their account.
- Assist patients with payment plans as needed and/or updating addresses for accurate mailings.
- Be a resource person for providers and administration regarding coding documentation and other issues related to coding and billing.
- Participate in the orientation process for new providers and monitor to ensure coding compliance.
- Keep the department Manager updated with any changes, concerns or issues regarding patients, programs, daily operations, outreach events, equipment needs, etc.
- If bilingual, accurately and professionally interpret conversations.
- If not bilingual, use appropriate and approved communication tool as needed.
- Develop and maintain relationships with other ODHC staff to ensure efficient daily operations of all departments.
- Be knowledgeable of ODHC services to provide integrated care to assist patients/families in accessing needed resources.
- Know, understand, and ensure adherence to the organization’s policy related to the patients’ right for confidential care and HIPAA.
- Keep updated on ODHC current events, changes in the workplace, policies and procedures.
- Read email, Intranet, and other communication tools on a regular schedule and respond in a timely manner to requests, where applicable.
- Perform other tasks as assigned.
Knowledge, Skills, Abilities, Qualifications:
- Formal education beyond high school.
- Experience related to dental coding and billing.
- Knowledge of dental terms, insurance, EHR and Microsoft Office Suite programs.
- Exceptional verbal and written communication skills.
- Excellent time management and organizational skills.
- Strong interpersonal skills.
- Ability to solve problems effectively.
- Confidence, professional judgement and grace under pressure.
- Accounting experience is a plus.
- Bilingual language skills are a plus.
This position is full-time, non-exempt, 8am-5pm, Monday through Friday with some flexibility needed for special projects/deadlines. Travel is required to meetings, events and to support other clinic locations within the community and across the region. Means of travel and travel expenses will be reimbursed according to ODHC’s travel policy. Physical ability to sit for extended periods of time. Position requires repetitive use of fingers, hands, wrist in job related duties, i.e. telephone, computer. Complete range of motion, including fine motor skills and tactile sense of both hands. Able to lift 25 pounds. This document is intended to describe the general nature and level of work performed and is not intended to serve as an exhaustive list of all duties, skills and responsibilities required of personnel so classified.