Job Summary
To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Job Responsibilities
- Review each claim for assigned offices for accuracy of provider of service, claim billing address, dental code utilized as reflected in clinical notes and proper patient information (name, dob, subscriber ID, etc)
- Identify procedures that need attachments (x-rays, periodontal charting and narratives). Make sure all required attachments are attached as required before claim is sent
- Ensure all claims are sent within 24 hours of service date
- Responsible for all claims for assigned offices to be resolved within 30 days
- Research, track and document in a clear and concise manner claim status and reasons for any delay in claim adjudication
- Analyze and interpret existing file notes and coverage documentation to competently respond to claim rejections or requests for additional information
- Handling of difficult or non-routine claims and adjustment projects by partnering with Office Managers and Support Center Staff
- Analysis, tracking and trending of claim issues and payor payment cycles to improve internal processes
- Perform other duties as assigned
Required Education and Experience
- High School Diploma
- At least 3 years dental claims experience
- 2-3 years previous leadership experience
Qualifications
- Knowledge of Dentrix Core and Ascend PMS systems
- Microsoft Excel Creation and basic functional working knowledge
- High attention to detail and accuracy
- Ability to meet set quota expectations
Physical Requirements
- Sitting and typing for long periods
The above statements are intended to provide a general overview and level of work being performed by most people assigned to this job. They are not intended to be a list of all responsibilities, duties and requirements. Additional duties can be assigned as determined.
Elite Dental Partners is an Equal Opportunity Employer. We support a diverse workforce.
We take great pride in helping our communities be healthier, feel better, and smile with confidence. Daily, we are driven by our vision to provide an elite patient experience tailored to their needs to receive the best care possible.
Not only do our team members find it rewarding to help patients be healthier, but they also enjoy being part of an organization that supports their growth. Our commitment to professional development and promoting internally when appropriate allows for tremendous career opportunities.