Billing Specialist - Dental

Great Lakes Bay Health Centers•Saginaw, MI

1d•Hybrid

About The Position

The Billing Specialist role is a multi-level position with responsibilities that vary based on the level (Entry Level, Senior Level, or Senior/Certified Level). The core functions involve submitting claims, processing payments and rejections, resolving billing issues, and maintaining accounts receivable. Higher levels involve mentoring, trend analysis, independent work, and potentially assisting with lead duties. The role requires accuracy, attention to detail, and effective communication with insurance companies and patients to ensure timely revenue collection.

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)
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. In depth knowledge of rejected claims and payor guidelines which includes minimal resubmissions, corrected claim submissions, appeals and understanding timely filing limits. 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.

Nice To Haves

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

Responsibilities

Ensure all claims are submitted for prompt payment.
Review, batch, and transmit/print claims/statements as assigned in a timely fashion.
Work any rejected files/claims/statements at time of submission to ensure all claims sent were received at Clearinghouse and sent to insurances/patients.
Monitor the assigned AR to ensure maintenance of a days in AR ratio of less than 90 while maintaining 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 to ensure we balance deposits to postings for every batch.
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 and 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.
Senior Level Billing Specialist will need to have the advanced skill set and knowledge to review AR and find trends in rejected claims and research why it was rejected and how it can be fixed.
Ability to work well with others and train staff while taking the initiative to resolve issues and know who to call and how to follow through.
Knowledge of all aspects of the department is required and expectation that they can and will assist Management in following the Billing Department policies.
Senior Level Specialists with Certifications (CPC, RHIT, RCC or a degree) and/or Assistant Duties are responsible for providing support/assistance to that specified Department.
This requires specific knowledge and additional work at this level and the ability to coordinate with staff and work with no supervision understanding the details needed to complete the task accurately and in a timely manner.