Medical Biller

*Contract to direct hire opportunity. 1 year dental billing preferred.

**5 days onsite downtown Detroit.

***20-24 per hour

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.

RESPONSIBILITIES

• Prepares complex claims for dental services.
• Prepares claims adjustments, as necessary, (i.e., claims paid to wrong provider, refund requests, overpayments, etc.).
• Analyzes, researches, and resolves various claims-related issues (rejected claims, unbilled claims and/or improperly resolved claims) with limited supervision.
• Initiates investigation of questionable claims; may refer recommendations to Revenue Cycle Team. Refers complex or unusual issues to the Revenue Cycle Team for guidance.
• Informs Leadership of any claims related issues that affect the proper adjudication of claims.
• Ensures that the patients’ insurances are correctly entered into the system and that they are current at least three (3) days prior to patients’ arrival.
• Completes required reports as requested, (i.e., Billed Claims Report, Service Activity Log, (SAL) Reports, Medical Record Request Reports, Claims Payment Reports, etc.).
• Meets and exceeds production quantity and quality standards, as determined by Leadership.
• Completes dental provider credentialing process for existing and new insurances before treating respective patients as needed.
• Research patients’ insurance copay amounts, provide information to front desk staff to ensure that the patient makes payment before treatment is performed.
• Pre-authorize and confirm all necessary dental procedures are covered prior to the start of patient treatment.
• Ensures payment of dental claims – bill accurate claims with required attachments, works denied claims and discover billing issues in order to receive optimal payment of claims.
• Trains staff in the dental billing processes and procedures as needed.
• Must maintain confidentiality relating to treatment in accordance with HIPAA guidelines
• Interacts verbally and in writing with team members throughout the company, as needed.
• Performs other duties as assigned.

EDUCATION AND EXPERIENCE

• High school diploma or equivalent required
• advanced dental claims processing experience preferred.
• 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.

How to Apply: