Billing Specialist - Dental

Great Lakes Bay Health Centers•Saginaw, MI

62d

About The Position

The Billing Specialist is responsible for submitting claims promptly, processing and posting payments, working rejected claims, and assisting with billing and payment issues. The role researches rejections and takes corrective action for prompt resubmission to help maximize revenue collection. The position has three levels: Billing Specialist I (entry level), Billing Specialist II (senior level), and Billing Specialist III (senior/certified level). Senior specialists mentor and support other staff, monitor trends, communicate billing issues, maintain accounts receivable, and work independently. Level III staff with certifications or higher education may also perform assigned assistant or lead duties and support departmental operations. The role includes preparing and transmitting claims and statements; maintaining assigned accounts receivable; processing payments and rejections; resolving rejected claims; and assisting with patient accounts and customer service. The specialist communicates with patients and insurance carriers, helps arrange payment plans, handles account follow-up and incoming mail, and may assist other specified positions with applications and related paperwork. The position requires extensive local travel between sites and occasional travel to seminars, with mileage and travel reimbursement according to the GLBHC travel policy.

Requirements

High school diploma for Billing Specialist I and II.
For Level I: coursework in medical or dental billing, or at least one year of medical/dental billing experience that includes processing and following through on EOB and ERA files, or a combination of coursework and experience.
For Level II: an associate degree in medical or dental billing or at least two years of medical/dental billing experience (three years desired), including EOB/ERA processing, knowledge of CPT, ICD-10, LCDs, NCDs and modifier guidelines, rejected and corrected claims, payer guidelines, appeals, timely filing limits, and Medicaid and Medicare billing, or a combination of coursework and experience.
For Level III: an associate degree and/or billing certification (CPC, RHIT, or RCC), and at least three years of medical/dental billing experience (five years desired), including EOB/ERA processing, CPT, ICD-10, LCDs, NCDs and modifier guidelines, rejected and corrected claims, payer guidelines, appeals, timely filing limits, and Medicaid and Medicare billing.
For Level II and III, knowledge of CPT, ICD-10, LCDs, NCDs, modifier use and guidelines, rejected claims, payer guidelines, corrected claims, appeals, and timely filing limits; Medicaid and Medicare billing experience is required.
Strong data-entry skills and ability to accurately enter high volumes of information.
Adept math skills and ability to perform reconciliation functions.
Organized and detail-oriented, with good computer skills and proficiency in Outlook, Word, and Excel.
Proficient 10-key skills.
Strict adherence to HIPAA guidelines and ability to work rejections independently to resolve issues and obtain timely claim payments.
Ability to multitask, maintain productivity and accuracy, work under pressure, and understand the collections process.
Trainable, able to follow specific instructions, communicate effectively with staff, patients, and management, work with limited supervision, and keep current with job duties.
Senior-level staff must be able to work without supervision, take on additional responsibilities, assist the Director as needed, and treat everyone with respect.
Ability to sit, stand, and/or walk for an entire workday and occasionally lift, carry, push, pull, and/or twist while holding up to 25 pounds.
Extensive local travel between sites and occasional seminar travel.

Nice To Haves

Bilingual English/Spanish skills.
Experience in a family or dental practice.
For Level II, three years of medical/dental billing experience is desired.
For Level III, five years of medical/dental billing experience is desired.

Responsibilities

Review, batch, and transmit or print claims and statements in a timely manner.
Work rejected files, claims, and statements at submission to confirm they were received by the clearinghouse and sent to insurers or patients.
Maintain assigned accounts receivable, targeting a days-in-AR ratio below 90 while maintaining the standard gross collection ratio.
Work proactively with insurance companies and patients to resolve payment issues, communicate backlogged accounts receivable to the Manager, and work credit balances within 60 days.
Process and post credit card, EOB, and ERA payment files accurately and promptly, balancing deposits to postings for each batch.
Coordinate with billing staff to ensure payments, deductibles, and copays are posted monthly.
Enter CAS and rejection codes, dates, and coordination-of-benefits information when posting; approve secondary claims for transmission the day after posting.
Research and resolve rejected claims, including contacting insurers, correcting claims according to payer requirements, and following through on resubmission.
Communicate claim issues to the Manager and staff.
Answer calls from patients and insurance carriers and provide accurate information to resolve claim-related issues and collect payment for services.
Initiate payment plans, review patient accounts, pursue payment, and resolve outstanding visits and credit balances.
Advise patients of past-due balances, seek payment or budget plans, and coordinate applicable collection-agency balances.
Handle incoming mail as instructed by the Manager and assist other assigned positions, including preparing applications and related paperwork.
At senior levels, mentor and train staff, review accounts receivable and rejection trends, research causes and solutions, support management with departmental policies and duties, and work independently.
At Level III, provide support to specified departments as assigned and coordinate work accurately and promptly with staff.