** Please note that this position will work remotely after a minimum of 6 months of onsite training in the Winter Garden, FL office **
A career at Community Health Centers offers a unique opportunity to join a team that makes a real impact in our community every day, by improving individuals' health while enhancing their quality of life.
Top Reasons to Work at Community Health Centers
$ads={1}
- No weekends for the majority of our centers, 10 Paid Holidays and early Fridays
- A great benefits package that includes healthcare coverage, paid time off, paid holidays, retirement plan, and more.
- Competitive compensation with advancement opportunities and tuition / training reimbursement.
- Awarded “Best and Brightest Companies to Work for in the Nation” in 2018, 2019, 2020, 2021 and 2022.
- Awarded “Top 100 Workplaces for Growing Families” by Orlando Sentinel.
- Modernized and attractive health centers, that patients love.
Job Summary:
The Dental Billing Representative will review all assigned claims for billing accuracy and compliance with payer policies and requirements. Responsible for filing and ensuring all third-party payer claims are paid timely. Responsible for completion of all duties and reports listed on the Billing Guidelines.
Primary Responsibilities and Specific Duties:
- Review claims for accurate CDT coding, accurate tooth number and surfaces and submit following individual dental payer guidelines.
- Reviews claims for accuracy in accordance with Medicaid and Managed Care policies.
- Reviews dental module for frequencies, x-rays and documentation required for narratives.
- Utilize dental payer portals to submit corrected claims and claims requiring X-rays and narratives.
- Transfers balances to patient's responsibility on non-covered items, benefits denied, or charges applied to the deductible.
- Researches and ensures corrections are made on denied claims due to missing or incorrect information.
- Ability to check dental insurance eligibility and review benefits, frequencies and patient history.
- Dental Payment posting along with the posting of insurance and patient refunds.
- Performs insurance collection (follow-up) function utilizing the collection system management and aging reports. As a part of this function generates and reviews aging reports to submit to insurance carriers when appropriate and in accordance with established guidelines.
- Runs paper claims when necessary and submits claims to appropriate fiscal intermediary.
- Prepares all refund paperwork for accounts payable and enters adjustments into the eClinicalWorks (eCW) System.
- Maintains current knowledge of all Medicaid policies and procedure updates.
-
Self-Pay Collection:
- Reviews and appropriately places account claims in the collection management system in eCW.
- Following collection guidelines, sends collection letters and establishes phone conversations concerning outstanding balances.
- Establishes payment arrangements with responsible parties for outstanding balances.
- Processes all returned mail according to established policy and procedure.
- Processes all incoming patient correspondence and answers all patients' questions regarding their account balance.
- Processes electronic file for monthly patient statements.
- Makes necessary adjustments to correct patient accounts for correct billing.
- Provides recommendations to Billing and Coding Manager regarding account disposition (collection agency placement, write-off discharge, etc.).
- Reports billing challenges to the Billing & Coding Manager and/or Patient AR Manager.
- Answers questions related to insurance and patient dental billing for all internal/external customers.
- Ensures accuracy of payments received from third party payers per contracts and current reimbursement rates.
- Posts contractual adjustments as required to Medicaid, HMO, PPO and other accounts per contracts and current reimbursement rates.
- Collects and posts payments and completes appropriate forms/reports and submits daily to Billing and Coding Manager and Bookkeeper.
- Performs all other duties as assigned.
Qualifications:
Education:
- High School Diploma or equivalent is required.
Experience:
- One year of dental billing and collection background and experience in a physician practice setting is required.
- Must be experienced in working with eClinicalWorks or other similar medical software products.
- Must have basic knowledge of medical terminology.
- Must have good communication and customer service skills.
Certification/Licensure:
- NA
Special Skills:
- Must understand the billing procedures for Medicare/Medicaid, Workers Compensation, HMOs, PPOs and other managed care and commercial insurance plans.
- Must have knowledge of state credit laws and regulations and generally accepted collection practices.
- Ability to read, understand, and follow oral and written instructions.
- Maintain patient confidentiality.
- Excellent communication and customer service skills.
Other requirements:
- Able to work flexible hours as needed.
$ads={2}
