Revenue Cycle Specialist

Revenue Cycle Specialist

Cherry Tree Dental is seeking a detailed-oriented and results-driven Revenue Cycle Specialist to join our team. This role plays a critical part in supporting efficient clinic operations by ensuring accurate patient and insurance information prior to treatment and managing full revenue cycle to optimize reimbursement and cash flow. While this role will primarily be remote, it will require occasional travel to Cherry Tree Dental clinical sites, work locations, and schools, therefore candidates should be within a reasonable distance of Madison, WI.

Key Responsibilities:

• Insurance Verification
• Verify patient insurance eligibility and benefits prior to scheduled appointments.
• Review and confirm coverage details, including annual maximums, deductibles, frequency limitations, waiting periods, and coordination of benefits.
• Accurately document verified insurance benefits in the practice management system to ensure reliable financial and clinical workflows.
• Patient Plan Management
• Create, update, and maintain accurate insurance plans within the practice management system.
• Ensure patient plans contain correct payer information, group and policy numbers, and coverage details.
• Conduct routine audits of insurance plans to identify inaccuracies and remove outdated or duplicate records.
• Ledger and Claims Management
• Submit insurance claims daily in a timely and accurate manner.
• Manage payor portals and regularly retrieve EFTs and ERAs from insurance websites.
• Post insurance payments and contractual adjustments accurately to patient ledgers.
• Perform consistent follow-up on aged insurance claims to ensure proper reimbursement.
• Forward aged accounts to collections as appropriate and post payments received from collection agencies.
• Assist with identifying, processing, and reconciling patient refunds.
• Pre-Treatment Revenue Cycle Support
• Review clinic schedules to confirm insurance eligibility and benefits prior to patient visits.
• Collaborate with clinic teams to resolve insurance discrepancies before treatment is rendered.
• Support the development of accurate treatment estimates based on verified insurance benefits.
• Claim Prevention and Denial Resolution
• Proactively identify insurance setup or eligibility issues that may result in claim denials.
• Partner with billing and accounts receivable teams to correct systemic insurance configuration issues.
• Track and analyze denial trends related to eligibility, benefit verification, or plan setup errors.
• Collaboration with Operations
• Work closely with office managers and clinic teams to improve insurance verification and billing workflows.
• Provide guidance and training on proper insurance data entry and verification procedures.
• Communicate common insurance challenges that may impact patient billing and collections.
• Revenue Cycle Process Improvement
• Identify trends in insurance errors, eligibility issues, and claim denials that affect revenue performance.
• Recommend process and workflow improvements to enhance overall revenue cycle effectiveness.
• Participate in ongoing Revenue Cycle Management (RCM) optimization initiatives.

What We're Looking For:

• High school diploma or equivalent
• Associate's degree in healthcare administration, business, or related field preferred
• Two (2) years of experience in dental or healthcare revenue cycle management.
• Proficient or the ability to become proficient within 90 days in dental software.
• Strong understanding of dental insurance verification and benefit structures
• Knowledge of claims submission and insurance billing processes.
• Strong attention to detail and critical thinking skills.
• Knowledge of insurance denial management and accounts receivable follow-up preferred.