Dental Billing Specialist

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Requirements:

• Minimum of 2-3 years of dental billing experience within the US healthcare system, preferably in a dental office or dental practice.
• Familiarity with dental insurance plans, dental coding (ADA, CPT, ICD-10), and payment posting.
• Experience with electronic health record (EHR) systems and dental billing software (e.g., Dentrix, Eaglesoft, Open Dental, etc.) is highly regarded.
• Strong understanding of dental insurance processes, claims submission, and denial management.
• In-depth knowledge of HIPAA compliance, medical billing, and coding standards.
• Familiar with various insurance companies and government payer programs (Medicaid, Medicare).
• Excellent attention to detail and strong organizational skills.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
• Strong communication skills, both written and verbal, to interact effectively with patients, insurance companies, and team members.
• Ability to work independently and as part of a team.

Responsibilities:

• Accurately prepare and submit dental claims to insurance companies, including both primary and secondary claims.
• Ensure that claims are submitted with the appropriate coding (CPT, ICD-10, ADA codes) and in compliance with insurance policies and healthcare regulations.
• Perform detailed insurance verification to confirm patient benefits and eligibility.
• Work with dental providers to clarify any issues related to billing, documentation, or coding.
• Post insurance and patient payments, including the allocation of payments to the correct accounts and codes.
• Reconcile discrepancies in payments or denials, ensuring accurate account balances and patient statements.
• Review, investigate, and resolve claim denials or underpayments, including resubmitting claims and appealing insurance decisions when necessary.
• Coordinate with insurance providers to resolve issues and ensure timely payments.
• Address and resolve patient inquiries regarding billing, payments, and insurance coverage.
• Provide clear and concise explanations of charges, coverage, and financial responsibilities.
• Assist with establishing payment plans when necessary.
• Generate and maintain reports on billing activities, denials, payments, and outstanding claims.
• Ensure compliance with HIPAA, insurance regulations, and other federal or state-specific guidelines.
• Work closely with the dental office team (front office, clinical staff, management) to ensure smooth billing and collections processes.
• Communicate effectively with external insurance providers to resolve any issues impacting billing or payments.