Claims Coordinator

Lightwave Dental • NC

80d

About The Position

CarolinaDentist is a fast-paced practice where we have fun while taking great care of our patients and making lasting relationships with them and team members alike. We are looking for team members that are self-driven, competitive and humbly confident. Our office is focused on personal and professional growth for all team members and encourage each other towards their goals. The Claims Coordinator ensures accuracy and timely filing for all dental claims for assigned office and reports problems and issues on follow up report to dental office. Reviews Accounts Receivable reports on assigned rotation for all offices, following up on outstanding insurance claims and balances; working problem EOBs, denials, and processing appeals as needed.

Requirements

• Previous experience in dental office administration, dental billing, or insurance claims processing is highly beneficial
• Familiarity with dental terminology and procedures is essential for accurately processing claims and communicating with dental providers and insurance companies
• A good understanding of dental insurance policies, coverage limitations, and claim submission procedures is necessary
• Attention to detail to accurately review claims, ensure all necessary information is included, and identify any discrepancies or errors
• Strong communication skills for interacting with patients, dental providers, insurance companies, and other staff members
• Ability to effectively manage and prioritize multiple tasks, such as processing claims, following up on outstanding payments, and resolving claim disputes
• Proficiency with dental practice management software and other computer applications used for claim processing and administrative tasks
• Good customer service skills for addressing inquiries and concerns in a professional and empathetic manner
• Ability to troubleshoot issues related to claim processing, billing errors, or insurance coverage discrepancies
• Knowledge of and adherence to legal and ethical guidelines related to patient privacy (HIPAA) and billing practices

Responsibilities

• Reviews clinical note, x-rays, and account ledger for cohesion of information
• Creates and submits e-claims and paper claims attaching any necessary x-rays, notes, narratives, charting, etc. This includes ortho claims
• Sends claims through clearing house and manages all invalid and rejected claims
• Ensures claims are sent out within 48 hours of the date of service
• Includes any account or claim issues on a Follow Up report to the dental office or assigned to the designated DO team member within PMS with the expectation that answers and corrections will be made within 48 hours of sending the report
• If accounts are unresolved from the dental office from the follow up report, an Urgent Weekly Report goes to the dental office
• Files corrected claims triaged from the AR Specialist based on returned problem EOBs
• Manages Accounts Receivable report on an assigned schedule, reviewing accounts for outstanding insurance claims and balances
• Calls and follows up with insurance companies on claims issues and non-payments
• Maintains and completes all appeals and requests from insurance companies
• Reviews returned EOBs: Denials- manages info needed for appealing claims, manages info needed for missing information or attachments, Corrected claims and/or retractions
• Tracks all outstanding insurance balances by category and reports to OM when completed
• Participates in special projects and tasks as assigned
• Fills in for other Claims/AR Coordinators as needed
• Assists and conducts training of new CBO team members
• Attends and contributes to monthly meetings
• Reports to CBO-RCM with any grievances or issues

What This Job Offers

• Number of Employees: 501-1,000 employees