Billing Specialist

Job Description

The Billing Specialist Dental is responsible for the patient registration process, insurance verification process, and financial arrangement issues at the dental clinic. This position verifies third party payer accounts, pre-authorization and/or pre-certification requirements. In addition to these responsibilities the Dental Billing Specialist, will be responsible for all dental billing functions and any subsequent Medicaid/Private payer audits. This position assists patients with questions regarding bills and insurance, and alternative payment plans.

The Dental Billing Specialist will be responsible for interfacing with all private payers or their designees (such as EviCore and Navinet) to obtain authorization for antepartum imaging, diagnostic testing, and lab studies and will facilitate physician to physician peer reviews of questionable cases. This position assures assignment of appropriate CPT and ICD-10 codes, collects quality statistical information, and assures timely follow up and processing of all accounts. Performs charge data reconciliation of all dental accounts. This position also collects data for statistical and/or financial analysis.

The Dental Billing Specialist communicates and collaborates with the dental team members including providers and provides quality customer service. This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation.

Qualifications

EDUCATION: High School diploma or equivalent required. Associates degree or higher preferred. Ability to read, write, and speak English is required. Bi-Lingual preferred.

Experience:

• 5 years prior experience in hospital and professional billing office, billing, insurance or other related healthcare field required
• Minimum of 1 year prior experience in lead experience, either officially or can demonstrate with prior examples of experience required
• Excellent computer skills and working knowledge of medical terminology required.
• Working knowledge of Microsoft Windows Office applications and data entry functions required.

Performance Expectations

Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position.

Work Environment

Potential for exposure to the hazards and risk of the hospital environment, including exposure to infectious disease, hazardous substances, and potential injury.

This position requires reaching, stooping, kneeling, and crouching approximately 25% of the workday. This position also requires frequently lifting, approximately 25-30 pounds, and occasional lifting of 50-100 pounds with assistance.

The essential functions for this position are listed on the Assessment and Evaluation Tool.

Reporting Relationship

This position reports to department leadership.