Dental Claims Resolution Specialist

PDS Management Services•Suffern, NY

9d•Onsite

About The Position

Our organization operates a growing network of dental practices across New York State and New Jersey. We're looking for a detail-oriented, analytical Dental Claims Resolution Specialist to join our centralized Revenue Cycle Management (RCM) team. In this role, you'll take ownership of outstanding dental insurance claims across multiple practice locations - researching denials and rejections, resolving underpayments and suspended credits, reconciling insurance payments, and working directly with insurance carriers and practice teams to keep accounts receivable clean and current. This is an ideal opportunity for someone who enjoys solving problems, working with numbers and claims data, and seeing an issue through from investigation to final resolution.

Requirements

High school diploma or equivalent.
Minimum 2 years of experience in dental or medical insurance claims, billing, or accounts receivable follow-up.
Working knowledge of dental insurance claim processes, EOB/ERA interpretation, and CDT procedure codes.
Experience with dental or medical practice management software and insurance clearinghouses.
Strong Microsoft Excel skills, including the ability to work with pivot tables and reconcile data from multiple sources.
Excellent attention to detail and strong analytical and problem-solving skills.
Ability to trace discrepancies back to their root cause across multiple documents and systems.
Strong written and verbal communication skills.
Ability to manage a high volume of claims across multiple practice locations while meeting deadlines.

Nice To Haves

Associate's degree in healthcare administration, business, or a related field.
Prior experience working in a multi-location dental service organization (DSO) or group dental practice.
Experience with New York State and New Jersey Medicaid Managed Care dental plans.

Responsibilities

Review, research, and resolve outstanding, denied, rejected, and underpaid dental insurance claims across multiple practice locations.
Investigate suspended credits and payments that have not been properly attached to a patient account or claim, tracing insurance remittance information back to the correct patient encounter.
Compare insurance EOBs and ERAs against payments posted in the practice management system to identify and correct discrepancies.
Review completed procedures that were not attached to or billed on an insurance claim and take the necessary steps to ensure billable services are properly submitted.
Prepare and submit corrected claims, reconsiderations, and formal appeals with appropriate supporting documentation while tracking claims through final resolution and within applicable timely filing deadlines.
Contact Delta Dental, Medicaid, Medicaid Managed Care plans, commercial dental payers, and other insurance carriers through phone, payer portals, and clearinghouse tools such as DentalXchange.
Review AR aging reports and prioritize follow-up on high-dollar and aged claims to minimize outstanding balances and potential write-offs.
Verify patient eligibility, insurance coverage, and benefit information as needed to support claim resolution and prevent recurring issues.
Monitor denial and rejection patterns across payers and locations and communicate opportunities to improve front-end processes, coding, or documentation.
Partner with front-office and clinical teams to resolve coding, documentation, data-entry, or scheduling issues that may be delaying claim payment.
Keep thorough and accurate notes on claim status, research, communication, and resolution steps within the practice management system.
Assist with month-end and period-end reporting related to suspended credits, unresolved claims, and aged receivables, including spreadsheet-based payment reconciliations.
Follow HIPAA requirements and applicable New York State insurance regulations when handling patient, claims, and payment information.
Assist with internal and external audits involving insurance claims and payment posting as needed.