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Insurance Claims Processor - Full-Time In San Antonio, TX

Smile Brands Inc.

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Position Summary

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.

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