UNIV - Dental Billing Specialist - College of Dental Medicine

Medical University of South Carolina•Charleston, SC

1d•$46,206 - $78,540

About The Position

The Dental Billing Specialist supports the College of Dental Medicine’s revenue cycle through billing, coding and modifier review, claims processing, payment posting and reconciliation, accounts receivable management, insurance follow-up, patient account resolution, and payment plan administration. The role helps ensure accurate and timely reimbursement by reviewing and submitting claims, managing denials, reconciling accounts, reviewing charges, conducting compliance-focused audits, and communicating with patients, providers, staff, students, and third-party payers. The specialist researches and corrects claim, charge, coding, modifier, and account issues; audits charts and accounts; posts and reconciles insurance and patient payments; handles corrections, appeals, reconsiderations, and resubmissions; and follows up on unpaid, denied, underpaid, rejected, or aging claims. The role also verifies insurance, updates patient and coverage information in the EHR, resolves payment and credit-balance issues, processes eligible refunds, maintains accurate records, prepares reports, and assists with complex account matters. The specialist serves as a resource for faculty, staff, and students on billing, coding, patient accounts, and related procedures; provides courteous service to patients and other stakeholders; and participates in special projects, process-improvement initiatives, workflow development, and training. Other duties may be assigned.

Requirements

High school diploma.
Three years of professional experience in a related area, such as accounting, auditing, finance, or commercial lending.
A bachelor's degree with multiple accounting courses may substitute for two years of the required work experience.
Computer literacy.

Responsibilities

Review charges in Charge Review and Modifier Review work queues for coding, modifier, documentation, or billing issues affecting claim submission and reimbursement.
Research and correct claim, charge, coding, and modifier errors using clinical documentation, EHR records, payer responses, and account activity.
Audit accounts and charts to verify coding accuracy, account balances, claim integrity, and supporting documentation.
Post and reconcile insurance and patient payments, electronic remittances, and paper explanations of benefits.
Establish, monitor, and maintain eligible patient payment plans in accordance with MUSC and CDM policies.
Process claim corrections, reconsiderations, appeals, and resubmissions, providing supporting documentation when appropriate.
Respond to patients and responsible parties about balances, billing questions, insurance claims, payments, and payment arrangements.
Respond to patient MyChart messages and Secure Chat requests from CDM faculty, staff, and students regarding billing and patient account concerns.
Monitor accounts receivable and follow up on unpaid, denied, underpaid, rejected, and aging claims.
Research claims processed incorrectly as out-of-network and work with participating insurance carriers to request correction or reprocessing when appropriate.
Research missing insurance payments and remittances and follow up to ensure payments are identified, posted, and reconciled.
Identify third-party payer payments, research deposited funds, and coordinate the transfer or correction of misapplied or misplaced payments.
Review and process paper and electronic correspondence requiring billing, payment, or claims follow-up, and document actions in patient accounts.
Research and resolve credit balances, unapplied payments, and overpayments.
Process appropriate refunds in accordance with MUSC and applicable State policies.
Maintain complete and accurate billing, payment, claim, and accounts receivable records.
Identify recurring account, denial, reimbursement, or collection trends and escalate significant concerns to leadership.
Correct patient demographic, guarantor, coverage, and insurance information in the EHR when necessary.
Perform insurance verification and identify eligibility, coverage, coordination-of-benefits, or other discrepancies requiring resolution.
Communicate with CDM faculty, residents, staff, and students about billing, insurance, and patient account issues.
Prepare routine and ad hoc reports related to missing charges, charge review, unapproved charges, payment activity, accounts receivable, and billing trends.
Research account history, claims, payments, adjustments, and documentation to assist leadership with escalated and complex patient account matters and coordinate resolution.
Serve as a resource and point of contact for CDM faculty, staff, and students on coding, billing, patient accounts, and related policies and procedures.
Provide guidance and support on billing and coding processes, account resolution, and applicable CDM/MUSC procedures.
Provide professional and courteous customer service to patients, responsible parties, payers, faculty, staff, and students.
Participate in assigned special projects, process-improvement initiatives, workflow development, and training activities.
Perform other duties as assigned.