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