Billing Specialist - Dental

Glbhc•Saginaw, MI

13d•Onsite

About The Position

The Billing Specialist I (Entry Level) is responsible for submitting timely claims, processing and posting payments, working rejected claims, and assisting with billing and payment issues. The Billing Specialist II (Senior Level) is expected to accurately process and post payments and rejections, find immediate resolution to billing issues, act as a mentor to Billing Specialist I, and monitor trends. The Billing Specialist III (Senior/Certified Level) staff, who are certified or have a higher level of education and additional Assistant/Lead duties, are responsible for communicating and performing any duties in that department when needed, working independently and ensuring tasks are completed accurately and timely. Essential Job Duties include ensuring all claims are submitted for prompt payment, reviewing, batching, and transmitting claims/statements, and working rejected files/claims/statements. Maintaining Accounts Receivable (AR) involves monitoring assigned AR to ensure a days in AR ratio of less than 90 and a standard gross collection ratio, collaborating with insurance companies and patients to resolve issues, and communicating backlogged AR to management. Credit balances must be worked within 60 days. Processing Payments and Rejections involves timely and accurate posting of Credit Card, EOB, and ERA payment files, coordinating with other billing staff to ensure all payments, deductibles, and copays are posted monthly, and inputting CAS codes, date, and COB information. Resolving rejected claim issues to ensure payment of claims requires timely work on all rejected claims, researching rejections by calling insurances, and following through on resubmission based on insurance requirements. Assisting the department in maintaining patient accounts and providing customer service includes answering telephone calls, providing accurate information to resolve claim-related issues, initiating payment plans, reviewing patient accounts for payment, verifying outstanding visits or credit balances, advising patients of past-due balances, and handling incoming mail. Acting as an assistant to other specified positions and preparing required paperwork are also duties. Marginal Job Duties include acting as backup to other Specialists as directed by the Manager. The Senior Level Billing Specialist needs advanced skills to review AR, identify trends in rejected claims, research reasons for rejection, and train staff. The Senior/Certified Level Specialists with certifications or degrees provide support and assistance to specified departments, requiring specific knowledge and the ability to coordinate with staff and work independently.

Requirements

High School Diploma
Coursework in Medical or Dental Billing OR Minimum of One (1) year of experience in Medical/Dental Billing including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files OR a combination of coursework and experience (for Billing Specialist I)
High School Diploma
Associates degree in Medical or Dental Billing OR Minimum of two (2) years’ required and 3 years’ desired experience in Medical/Dental Billing, including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files; 2) experience and understanding of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines; 3) experience working rejected and corrected claims, knowledge of payor guidelines and minimal resubmissions, handling appeals and understanding timely filing limits. Medicaid and Medicare billing experience. OR a combination of coursework and experience (for Billing Specialist II)
Associate degree and/or Billing Certificates (CPC, RHIT, RCC)
Minimum of three (3) years required and 5 years’ desired experience in Medical/Dental Billing, including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files; 2) experience and understanding of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines; 3) experience working rejected and corrected claims, knowledge of payor guidelines and minimal resubmissions, handling appeals and understanding timely filing limits. Medicaid and Medicare billing experience (for Billing Specialist III)
Knowledge of processing and following through on Explanation of Benefits (EOB) and ERA files including payments and Rejections (for Level I)
Knowledge of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines (for Level II & III)
In depth knowledge of rejected claims and payor guidelines which includes minimal resubmissions, corrected claim submissions, appeals and understanding timely filing limits (for Level II & III)
Medicaid and Medicare billing experience is required (for Level II & III)
Strong data entry skills
Ability to input a high-volume information accurately
Adept math skills with strong ability to perform reconciliation functions
Organized and detail oriented
Must have good computer skills, proficiency with Outlook, Word, and Excel
Proficient 10 key skills
Demonstrates strict adherence to HIPAA guidelines
Expertise in working rejections to resolve issues and obtain timely payment of claims independently
Ability to multi-task and provide a high level of productivity while maintaining accuracy
Must be able to work under pressure
Understand collection process
Desire to learn and master new things, seek help when needed and willingly assist others in time of need
Trainable and able to follow specific instructions
Ability to communicate effectively with other staff, patients, and management
Able to work with limited supervision and keep current with all job duties
Ability to treat everyone with respect
Must be able to sit, stand, and or walk for an entire workday
Must be able to lift, carry, push, pull, and or twist while holding up to 25 lbs. occasionally

Nice To Haves

Bilingual (English/Spanish) preferred
Experience in Family or Dental Practice

Responsibilities

Submission of timely claims
Processing and posting payments
Working rejected claims
Assisting with billing and payment issues
Researching and working rejections for immediate resubmission
Monitoring trends and communicating issues/updates to the department
Ensuring all AR is kept current
Ensuring all claims are submitted for prompt payment
Review, batch, and transmit/print claims/statements as assigned
Work any rejected files/claims/statements at time of submission
Maintain AR
Monitor assigned AR to ensure maintenance of a days in AR ratio of less than 90
Maintain a standard gross collection ratio
Work collaboratively and proactively with insurance companies and patients to resolve issues that will lead to payment
Communicate to Manager any backlogged AR
Ensure credit balances are worked within 60 days
Process and post Credit Card, EOB and ERA payment files timely and accurately
Coordinates with other billing staff to ensure all payments/deductibles/copays are posted monthly
Input CAS codes (including Rejection codes), date and COB information at time of posting
Approve secondary claim to ensure claims are transmitted to Secondary Insurances the day after posting
Responsible for resolving rejected claim issues to ensure payment of claim
Ensure all rejected claims are worked in timely fashion
Research rejections which include calling insurances to help understand what needs to be corrected and follow through on resubmission of claim based of insurance requirements
Communicate with Manager and staff on claim issues
Assists department maintaining patient accounts and providing customer service
Answer telephone calls from patients and insurance carriers, providing complete and accurate information to resolve any claim related issue in effort to collect payment on services rendered
Initiate payment plans and review patient account in efforts to obtain payment and clean up all visits on the patient account
Verify all visits that are outstanding or have credit balance are worked correctly and resolved
Advise patients of balances that are past due, attempt to obtain payment/set up budget plans and coordinate Collection Agency balances as applicable
Handle any incoming mail as instructed by Manager
Act as assistant to other specified positions as assigned
Prepare applications and any other required paperwork in efforts to complete processing of requested documents in a timely manner
Acts as backup to other Specialists as directed by Manager
Review AR and find trends in rejected claims and research why it was rejected and how it can be fixed
Train staff
Assist Management in following the Billing Department policies
Provide support/assistance to that specified Department
Coordinate with staff and work with no supervision understanding the details needed to complete the task accurately and in a timely manner