Generate and process all general and specialty claim, encounter and pre-authorization requests for submission to insurance carriers for reimbursement or approval.
Essential Duties and Responsibilities
- Process insurance claims on paper and electronic submission.
- Audit insurance claims
- Audit insurance claims to identify and provide required attachments, including digital images, pre-authorizations, periodontal charts, and narratives.
- Audit attachments for completeness and suitability
- Contact offices when needed information is needed using Insurance collaboration tool
- Review collaboration
- Upload claims to vendor for electronic filing.
- Monitor electronic claim status and work rejection and claim submission issues
- Correct rejected claims holding for electronic filing.
- Generate pre-authorizations.
- Resubmit claims upon office request
- Generate and review claims to HMO/DMO plans.
- Generate monthly encounters.
- Enter notes indicating date claim submitted in 29X; including NEA # for electronic attachments
- Review unbilled report for prior 90 days and generate missing claims as required
- Maintain library of accurate and up-to-date billing requirements documentation for payers and procedures
- Maintain library of accurate and up-to-date documentation regarding timely filing deadlines for all payer types, including HMO, Medicaid, and Workers Comp
- Ensure claim submission within timely filing deadlines
- Ensure claim submission for secondary coverage within timely filing deadlines
- Manage medical billing
- Take ownership of claim submission, ensuring timeliness, completeness and accuracy.
- Build relationships and maintain open communication with dental office staff, as well as internal departments and company representatives. Provide appropriate greeting, guiding and gratitude (G3) in verbal and written communications.
- Create and maintain dental office contact information.
- Continually review the billing process to ensure compliance; decide if a process should be stopped or changed or added and brought to the attention of manager before proceeding.
- Complete annual review of CDT code changes and requirements
- Produce department and company wide reports on a daily, weekly, monthly, quarterly and annual basis
What we Need From You
- High school diploma or general education degree (GED)
- Three to six months related experience and/or training
- General Dentistry, Oral Surgery, Periodontics, Orthodontics and Medicaid Dental claim billing experience, a plus
- Knowledge of CDT coding and terminology, a plus
- Ability to read dental radiographs, a plus
- Ability to work in a fast paced team environment
What We’ll Offer You
- Unparalleled support to grow your career
- A culture that celebrates success and diversity
- Benefits and perks for you, your family and even your pets!
- Medical, Dental, Vision, 401K and paid time off for full-time positions
Smile Brands Inc. and all relevant Affiliates are Equal Opportunity Employers. We are proud to celebrate diversity and provide an inclusive workplace for all employees.