UNIV - Dental Billing Specialist - College of Dental Medicine

Job Description

Job Description

Job Description Summary

The Dental Billing Specialist is responsible for billing, coding and modifier review, claims processing, payment posting and reconciliation, accounts receivable management, insurance follow-up, patient account resolution, payment plan administration, and related revenue cycle activities. The position supports accurate and timely reimbursement through claim review and submission, denial management, account reconciliation, charge review, compliance-focused auditing, and effective communication with patients, providers, staff, students, and third-party payers.

Entity

Medical University of South Carolina (MUSC - Univ)

Worker Type

Employee

Worker Sub-Type​

Classified

Cost Center

CC000058 CDM Dean Finance & Administration

Pay Rate Type

Hourly

Pay Grade

University-GEN08

Pay Range

46,206.00 - 62,322.00 - 78,540.000

Scheduled Weekly Hours

40

Work Shift

Job Description

30%:

• Review charges within Charge Review and Modifier Review work queues to identify coding, modifier, documentation, or billing issues that may affect accurate claim submission and reimbursement.
• Research and correct claim, charge, coding, and modifier errors through review of clinical documentation, EHR records, payer responses, and account activity.
• Perform account and chart audits to verify coding accuracy, account balances, claim integrity, and supporting documentation before billing follow-up or correspondence is completed.
• Post and reconcile insurance and patient payments, electronic remittances, and paper explanation of benefits (EOBs).
• Establish, monitor, and maintain payment plans for eligible patients in accordance with MUSC and CDM policies.
• Process claim corrections, reconsiderations, appeals, and resubmissions and provide supporting documentation when appropriate to resolve denials and support reimbursement.

30%:

• Respond to patients and responsible parties regarding account 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 perform timely follow-up on unpaid, denied, underpaid, rejected, and aging claims.
• Research claims incorrectly processed as out-of-network and work with participating insurance carriers to request correction or reprocessing when appropriate.
• Research missing insurance payments and remittances and initiate follow-up to ensure payments are properly identified, posted, and reconciled.
• Identify third-party payer payments, research deposited funds, and coordinate the transfer or correction of misapplied or misplaced payments to the appropriate patient account.
• Review and process paper and electronic correspondence requiring billing, payment, or claims follow-up and document actions taken within the patient account.
• 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.

30%:

• Correct patient demographic, guarantor, coverage, and insurance information within the EHR when necessary to support accurate billing and claim adjudication.
• Perform insurance verification and identify eligibility, coverage, coordination-of-benefits, or other discrepancies requiring resolution before or during billing follow-up.
• Communicate timely and accurately with CDM faculty, residents, staff, and students regarding 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.
• Assist leadership with escalated and complex patient account matters by researching account history, claims, payments, adjustments, documentation, and other relevant information and coordinating resolution.

10%:

• Serve as a resource and point of contact for CDM faculty, staff, and students regarding coding, billing, patient accounts, and related policies and procedures.
• Provide guidance and support regarding 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 while addressing billing questions, account concerns, insurance issues, and payment-related inquiries.
• Participate in assigned special projects, process-improvement initiatives, workflow development, and training activities.
• Perform other duties as assigned. 

Additional Job Description

Minimum Requirements: A high school diploma and three years professional experience in a related area such as accounting, auditing, finance or commercial lending. A bachelor's degree with multiple accounting courses may be substituted for two years of the required work experience. Physical Requirements: (Note: The following descriptions are applicable to this section: Continuous - 6-8 hours per shift; Frequent - 2-6 hours per shift; Infrequent - 0-2 hours per shift) Ability to perform job functions in an upright position. (Frequent) Ability to perform job functions in a seated position. (Frequent) Ability to perform job functions while walking/mobile. (Frequent) Ability to work indoors. (Continuous) Ability to work in confined/cramped spaces. (Infrequent) Ability to bend at the waist. (Infrequent) Ability to squat and perform job functions. (Infrequent) Ability to fully use both hands/arms. (Continuous) Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (Frequent) Ability to reach in all directions. (Frequent) Possess good finger dexterity. (Continuous) Ability to maintain tactile sensory functions. (Continuous) Ability to lift and carry up to 15 lbs., unassisted. (Infrequent) Ability to lift objects, up to 15 lbs., from floor level to height of 36 inches, unassisted. (Infrequent) Ability to lower objects, up to 15 lbs., from height of 36 inches to floor level, unassisted. (Infrequent) Ability to push/pull objects, up to 15 lbs., unassisted. (Infrequent) Ability to maintain 20/40 vision, corrected. (Continuous) Ability to see and recognize objects close at hand. (Continuous) Ability to see and recognize objects at a distance. (Continuous) Ability to match or discriminate between colors. (Continuous) Ability to determine distance/relationship between objects; depth perception. (Continuous) Good peripheral vision capabilities. (Continuous) Ability to hear and/or understand conversations. (Continuous) Ability to perform gross motor functions with frequent fine motor movements. (Continuous) Additional New Requirements: Computer literacy.

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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