Job description
SUMMARY: Under the general direction of the Chief Dental Officer, the Dental Billing Specialist works as support for the Dental Team performing those duties necessary to prepare patients for their dental visits and provide support to the Finance Department for accurate submission of dental claims and resubmission of denials.
PRIMARY DUTIES and RESPONSIBILITIES include the following: (other duties may be assigned):
Billing Specialist Duties (75%)
- Conduct Billing responsibilities in the Billing Department working directly with the Billing Team at a minimum of 2 Days a Week.
- Train Dental Patient Registrar and Dental Patient Coordinator with any current and new billing protocols and processes to support the Dental Department with optimal private Insurance and Medicaid Billing Practices and provide step by step training templates.
- Assist Billing Team along with CDO and other pertinent Dental staff with reviewing and posting of all denials for Medicaid and commercial insurances for MNHC.
- Assist with timely review, preparation and release of monthly denials received from the contracted billing company to share with Chief Dental Officer.
- Assist with processing refund request letters received from various payers and patients in a timely manner.
- Review Dental Claim Status for accuracy to assure that payment is received.
- Prepare weekly reports for all claim statuses to be reviewed by CDO, Accounts Payable and Receivable, and other assigned reports.
- Complete the file resolution inquiries for Medicaid and/or complete appeal forms for Medicaid and commercial insurance and review all patient accounts, including patients on the MNHC Slide Program.
- Assist Billing Staff with maintaining open claim reports and aging reports for Medicaid and Commercial payments.
- Attend trainings for Medicaid and other relevant Billing seminars as requested by CDO.
- Ensure proper submission of claims via mail/electronic means for payment approval, appropriate Dental Codes, Treatment Summary and providing the substantiating documents.
- Assist Dental Staff with proper correspondence letter for patients and/or insurance company stating reason for claim denial.
- Submit Day Sheet daily to CDO.
- Assist CDO with gathering of information to address Bad Debts according to MNHC Bad Debt Protocols.
- Assist Billing Department and Billing company with batch out posted charges and payments as needed and requested.
- Assist Billing Department with maintaining receipts of all incoming checks and payments for dental services.
- Verify patient insurance and conduct pre-authorizations for Medicaid and commercial insurances.
- Access NC Tracks to check eligibility and update benefit limitations for patient’s insurance coverage. Assist all Dental Staff with training and information needed in a proactive manner to ensure all needed insurance information is obtained prior to scheduled appointment.
- Assist Billing Team, Dental Patient Coordinator and CDO with patient billing, procedure codes and correction of billing errors.
- Ensure proper training of designated staff is complete within the 90 Day Introductory Period to ensure all aspects of the Front Desk are complete; competency check list is within proper guidelines using best proactive protocols including: designing and updating training templates for posting charges, collecting payments, open and closing daily journal; and end of day balancing of cash drawer.
- Attend Billing Meetings as requested by CDO.
- Complete all other duties as assigned.
Clinical Duties (25%)
- Conduct job duties in a professional and caring manner, creating a positive patient-oriented service atmosphere.
- Assist Dental Registrar and Dental Patient Coordinator with registering patients, appointment cancellations and/or rescheduling patient appointments; inclusive of scheduling referral appointments with specialists and scheduling pediatric patients.
- Consult with Chief Dental Officer to create templates for patient scheduling for dental providers as needed.
- Operate as a liaison with Dental EMR and Medical EMR in resolving system issues or related concerns with the support and assistance of the Dental Patient Coordinator.
- Assist with Monitoring radiation badges and biological monitoring system and send badges out quarterly for review with the support and assistance of Dental Patient Coordinator.
- Assist Dental Patient Coordinator with ensuring proper tracking of surgical procedures, progress notes are completed, time outs and consent forms are signed, no show appointment policy is signed.
- Assist Clinical Staff with reviewing inventory and ordering supplies for the dental department with the assistance and support of the Dental Patient Coordinator.
- Perform all duties as permitted by the Dental Laws of North Carolina and Board Rules handbook section .0203.
- Follow all OSHA standards and company policies as stated in Regulatory Compliance Manual and MedNorth Health Center Policies and Procedures Manual and MSDS.
- Always protect the confidentiality of patients and their records by complying with MedNorth Health Center’s patient confidentiality policy.
- Assist with scheduling of in-service with vendors and dental representatives i.e., Henry Schein, Benco, etc.
- Coordinate with the clinical department in scheduling follow-up appointments for MNHC family medicine, pediatrics and women’s health patients, as well as dental referrals and other programs as needed or assigned by the CDO.
- Review, complete and discuss your weekly checklist and provide updates to CDO.
- Assists the Chief Dental Officer, Dental Hygienist and Dental Assistants in preparing patients for treatment, processing dental x-ray film, pouring dental impressions, setting up instruments and dental materials, sterilizing instruments after patient treatment, chart dental anomalies and stocking supplies as needed.
Corporate Compliance: It is an essential job element that everyone be compliant with the full law and fully cooperate with the compliance program without fear of retaliation from the organization.
QUALIFICATION REQUIREMENTS: The requirements listed below are representative of the knowledge, skills, and/or ability required:
- Knowledge of standards of practice and procedures in a dental clinic.
- Possess the ability to communicate effectively with patients, staff and community groups.
- Possess the ability to understand technical and medical terminology as they relate to dentistry.
EDUCATION AND/OR EXPERIENCE:
- Certified Dental Assistant Certificate or Dental Assistant II Certification.
- 4 years of dental experience
- 2 years of billing experience
ESSENTIAL TECHNICAL/MOTOR SKILLS:
- The Dental Billing Specialist must understand dental terminology, have accurate keyboarding skills, and the ability to process work error free
- Ability to use standard office equipment, including computers, photocopiers, and facsimile machines
- Ability to learn, understand, and use Internet insurance eligibility and billing systems.
INTERPERSONAL SKILLS:
- Excellent interpersonal and customer service skills.
- Excellent telephone etiquette.
- Teamwork and communication skills are essential.
- Treat all patients, co-workers, and managers with courtesy and respect.
MENTAL ABILITIES:
- Cognitive reasoning.
- Clear thinking in high-pressure situations.
- Ability to prioritize and withstand pressure of continual work with variable requirements.
- Ability to concentrate and maintain accuracy despite frequent interruptions.
- Critical thinking and organization skills, problem solving, and reasoning capabilities.
LANGUAGE SKILLS:
- Ability to speak English fluently - Spanish speaking or another language is a plus.
LICENSES, CERTIFICATES, REGISTRATIONS:
- Certified Dental Assistant Certificate or Dental Assistant II Certification.
- Annual continuing education with OSHA for dental updates.
PHYSICAL DEMANDS: The physical demands described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to stand, walk, talk, and hear, use hands to finger, handle or feel. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee is frequently required to lift and/or move up to 20 pounds.
The special vision requirements for this job are close vision (clear vision at 20 inches or less), color vision (ability to identify and distinguish colors).
WORK ENVIRONMENT: The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions for this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
MedNorth Health Center provides comprehensive health care services inside a multi-cultural medical/dental clinic, to all individuals; insured, uninsured, and underinsured. The building is heated in winter and air conditioned in the summer with noise levels of moderate to loud. We serve patients who speak multiple languages and who may need the assistance of an interpreter. In this position one may be subject to exposure to copier toner, correction fluid, bright fluorescent lighting, and continuous personal computer exposure.
This job is a Blood borne Pathogens risk
category I position.
GENERAL EXPECTATIONS:
- The employee is expected to attend work on a daily basis and to be at work on time.
- The employee is expected to be a team player.
- The employee is expected to report absences in accordance with personnel policies and procedures.
- The employees’ work is expected to be accurate, neat, and thorough, and completed on time.
- The employee is expected to have a positive attitude, be cooperative, and considerate of others.
- The employee is expected to be dependable and is expected to accept responsibility for assignments and duties given.
- The employee is expected to dress and act in a professional manner and to adhere to all safety standards.
- The employee is expected to participate in staff meetings, be courteous and polite with patients and other staff.
- The employee is expected to maintain confidentiality.
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