Medical Billing AR Specialist
About The Position
The Medical Billing & AR Specialist is responsible for managing medical billing activities related to dental procedures, including medical claim submission, pre-authorizations, claim follow-up, denial resolution, and appeals. This role will also support dental insurance accounts receivable follow-up and other Revenue Cycle Management functions based on organizational priorities and business needs. This position requires strong knowledge of dental-to-medical billing and the ability to independently manage claims from initial submission through final resolution. The Medical Billing & AR Specialist will identify and report recurring denial and reimbursement trends, determine root causes, and provide actionable feedback to improve first-pass payment and reduce preventable rework. The role will also support the development and maintenance of documented internal medical billing workflows to promote operational continuity, cross-training, and consistent execution.
Requirements
- Demonstrated experience with medical billing for dental and/or oral procedures required.
- Experience with medical claim submission, medical pre-authorizations, claim follow-up, denials, appeals, and reimbursement resolution.
- Demonstrated experience working dental insurance accounts receivable required, including claim follow-up, denial resolution, corrected claims, appeals, and aging AR.
- Strong understanding of medical and dental insurance reimbursement processes and payer requirements.
- Experience interpreting EOBs/ERAs, payer responses, denial reasons, authorization requirements, and supporting clinical documentation.
- Familiarity with medical claim forms, coding requirements, and documentation standards applicable to dental procedures billed to medical insurance.
- Ability to independently research claim and reimbursement issues, determine root cause, and drive claims through resolution with minimal oversight.
- Strong attention to detail and ability to manage a high-volume workload while maintaining accuracy.
- Strong organizational, prioritization, and documentation skills.
- Strong Excel skills, including the ability to organize, filter, reconcile, and analyze claim and reimbursement data.
- Ability to identify patterns and translate claim-level findings into actionable trends and recommendations.
- Ability to collaborate effectively across RCM, clinical, operational, and other functional teams.
- Ability to work independently and effectively in a remote environment.
Nice To Haves
- Denticon experience strongly preferred. Candidates with significant dental-to-medical billing expertise and demonstrated ability to quickly learn complex practice management systems will also be considered.
Responsibilities
- Prepare and submit medical claims for eligible dental and oral procedures, ensuring accurate coding, required documentation, and payer-specific requirements are met.
- Manage medical pre-authorizations from initial submission through determination, including obtaining necessary clinical documentation, responding to requests for additional information, and performing timely follow-up.
- Perform follow-up on outstanding medical claims through final resolution, including payer outreach, corrected claims, reconsiderations, denials, appeals, and additional documentation requests.
- Review rejected and denied claims to determine root cause and take appropriate corrective action.
- Identify, track, and report recurring denial and reimbursement trends, including payer-specific patterns, documentation deficiencies, authorization issues, coding concerns, and other barriers to first-pass payment.
- Proactively escalate identified trends and recommend corrective actions designed to prevent recurrence and improve reimbursement outcomes.
- Work assigned dental insurance AR, including outstanding claims, denials, appeals, corrected claims, and other follow-up activities as organizational priorities and capacity require.
- Prioritize assigned AR based on aging, financial impact, timely filing requirements, payer response, and other established RCM standards.
- Maintain complete and accurate documentation of claim status, payer communication, actions taken, supporting documentation, and required next steps.
- Monitor claims through adjudication and ensure appropriate reimbursement or final disposition.
- Partner with clinical, operational, RCM, and other internal teams to obtain information necessary for claim submission, authorization, appeal, and resolution.
- Maintain accurate, current documentation of medical billing, pre-authorization, and follow-up workflows to support operational continuity, cross-training, and consistent execution.
- Participate in the development and improvement of processes designed to increase clean claim performance, first-pass payment, and overall AR resolution.
- Support additional Revenue Cycle Management functions and special projects as needed based on organizational priorities and business needs.
Benefits
- Flexible Health and Vision Insurance Plans
- 401(K) Retirement Plan with Matching
- Generous Paid-Time Off (up to 3 weeks)
- Annual "you" day for self-care
- Exclusive In-house Dental Program (Heavily discounted services for you and your immediate family)
- Extra Perks and Fringe Benefits
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
