Purpose: The Billing Representative is responsible for processing dental claims for payment by the insurance companies. Primarily review, investigate and resolve claims that have been denied by insurance or did not properly make it to the insurance company. The Billing Representative must utilize tools to ensure claims are processed and the account is adjudicated.
- Analyze issues on accounts and investigate primary/secondary claims.
- Ability to navigate multiple system information during claim resolution.
- Research to complete and respond to EOBs; review EOB to ascertain reason for denial. Communicate with insurance companies if unable to locate denial reason or if EOB is unclear.
- Process pre-determination responses from insurance companies and furnish additional information for processing.
- Review open practice communications and perform needed actions.
- Assemble correspondence from vendor, sort and distribute. Inspect documents that could not be distributed and evaluate.
- Prepare insurance address changes for insurance operations. Expedite provider issues to the credentialing department for follow up and resolution.
- Identify trends in the denials process with insurance companies, or internal systems logic breaks, and propose potential resolutions.
- Provide support to practices and doctors by answering insurance claim requests accurately and timely.
- Thoroughly review denied claims, obtain additional supporting information and compose appeal letters. If appeals submitted and denied, ensure all adjustments to account have been made and are accurate.
- Re-file and close claims; post adjustments; update insurance IDs; insurance priorities; insurance companies.
- Update patient demographic information including invalid or missing data (i.e. dependent and student status, age limit, etc.) as needed.
- Review audits and audit corrections on a weekly basis.
- Reach out to the practices for additional information requests as needed.
- Update tooth/surfaces requirements per charge as needed.
- Process charge-error corrections and negative production as indicated by days outstanding.
- Meet required productivity and quality expectations.
- Print claim, x-rays, narratives, periodontal charts for mailing or faxing.
- Continuous improvement requirements up to 4 hours a week.
- Perform administrative and project work, as assigned.
Required Skills and Experience
- High School Diploma required. Associates degree or technical training preferred.
- 2+ years revenue cycle experience required, dental (or healthcare) preferred.
This position requires that candidates embody the principles of our core values and demonstrate aptitude in the following areas:
- Analytical ability; Ability to analyze contracts, interpret metrics and understand workflows.
- Detail oriented focus; Ability to work with complex claims.
- Flexibility; Ability to adapt to change and willingness to take on new tasks.
- Interpersonal and relationship building skills; Ability to establish and maintain positive working relationships, internally and externally.
- Office proficient; Ability to utilize Fax, Copier, Scanner. Understand mailroom procedures, among other basic office functions.
- Process improvement-minded; Ability to enhance and develop performance by analyzing current data and processes along with openness to feedback and constructive criticism.
- Professional communication skills; Ability to tactfully present information in clear and understandable manner.
- Professional integrity; Ability to work independently with a high level of professionalism, dedication and commitment.
- Proficient with technology; Ability to utilize Microsoft Office applications, databases, EHR and practice management software, as well as, internet applications.
- Resourceful; Utilizes the resources available to you. If you don't know the answer to something find out by asking questions or seeking information
- Results‐oriented; Ability to meet deadlines and hold vendors accountable to service level agreement.
- Revenue Cycle Focused ; Ability to understand how revenue flows into and out of an organization
- Time management; Ability to prioritize and efficiently process claims.
- Office with cubicle environment, headsets may be utilized, but not required.
- Fast paced office environment.