Insurance Claims Auditor

Pacific Dental Services Irving , TX 75061

Posted 2 weeks ago


Now is the time to join Pacific Dental Services. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today!


The primary purpose and function of the Auditor, Insurance Claims is to adjudicate, re-bill and rebut insurance claims in order to ensure accurate and maximum reimbursement for patient treatment from insurance carriers.

  • Read and analyze EOB's and make proper adjustments according to PDS claims processing criteria

  • Sends appeals to insurance carriers with justification as to why dental treatment should be paid.

  • Audit accounts to ensure proper fees have been posted.

  • Works with CBO team to maximize office collections and minimize adjustments.

  • Communicate issues and suggestions to improve processes.

  • Ensure compliance with Company policies as well as State, Federal and other regulatory bodies.

  • Participate in meetings as required.

  • Maintain an appropriate professional appearance and demeanor in accordance with Company policy.

  • Other duties as assigned by management.


  • Equivalent to high school diploma or general education degree (GED).
  • 2-4 Years of related experience in the dental field.


  • EPIC knowledge.

  • Bachelor's Degree and 3 to 5 years of related experience.

  • Prior experience as a claims auditor within a group practice environment.


  • Ability to multi-task effectively without compromising the quality of the work.

  • Excellent interpersonal, oral and written communication skills.

  • Detail oriented, organized, process focused, problem solver, proactive, ambitious, customer service focused.

  • Ability to draw conclusions and make independent decisions with limited information.

  • Ability to respond to common inquiries from customers, staff, regulatory agencies, vendors, and other members of the business community.

  • Self-motivated, reliable individual capable of working independently as well as part of a team.

  • Problem solving skills to gather & analyze information in order to identify and resolve problems in

a timely manner arrive at valid conclusions, recommendations, and plans of action.

  • Analytical skills to synthesize complex or diverse information. Ability to research information and

analyze data to arrive at valid conclusions, recommendations, and plans of action.

  • Actively share ideas in a constructive and positive manner by listening to and objectively

considering ideas and suggestions from others.

Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Medical Claims Auditor I


Posted 3 weeks ago

VIEW JOBS 10/4/2020 12:00:00 AM 2021-01-02T00:00 HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare-now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others. We are seeking a talented individual for a Medical Claims Auditor I who performs research analytics to support our recovery audit line of business. Assists in the development and implementation of new data mining and audit/review methodologies for identifying healthcare overpayments and underpayments to providers, and the detection of healthcare fraud, waste, and abuse. Essential Responsibilities: * Participates in the review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements. Applies knowledge of provider billing and patient accounting practices to research of client policy and data to reveal new overpayment recovery opportunities. Works with data miners, clinical staff, and stakeholders to identify new overpayment issues for each client. * Tracks, and follows-up on results and recoveries * Contributes new ideas for improving existing audit processes and audit queries. Works cohesively with the audit team. * Develops, maintains, and ensures adherence to multiple project schedules Non-Essential Responsibilities: * Performs other functions as assigned Knowledge, Skills and Abilities: * Strong Conceptual and analytical skills * Strong Project management skills * Ability to develop, organize, and maintain project plans and agendas * Ability to effectively interface with clients on the phone and in person * Working knowledge of Microsoft Suite of products (Excel, Word, Access) * Sound understanding or medical terminology and anatomy. * Good understanding of Medicaid required, Medicare and commercial experience a plus. * In depth knowledge of coding principals including but not limited to NCCI Edits, CPT, HCPCS and ICD-9 codes and modifiers; and/or MSDRG, Revenue codes, and APCs. * In depth knowledge of UB04 and medical (1500) claim formats and requirements. Work Conditions and Physical Demands: * Primarily sedentary work in a general office environment * Ability to communicate and exchange information * Ability to comprehend and interpret documents and data * Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.) * Requires manual dexterity to use computer, telephone and peripherals * May be required to work extended hours for special business needs * May be required to travel at least 10% of time based on business needs Minimum Education: * High school diploma or GED required; * Bachelor's degree preferred Minimum Related Work Experience: * 1-3 years of healthcare reimbursement experience such as provider contract development, healthcare claims analysis, medical billing/coding, patient accounting, claims auditing, and/or revenue cycle improvement required. * Must have demonstrated experience and knowledge of healthcare claims processing (Medicaid, Medicare, Commercial Insurance), including ICD-9-CM codes, HCPCS codes, CPT codes, DRGs, physician billing, etc. preferred. * Experience in healthcare auditing, reviewing and validating the accuracy of claims data and accuracy of claims payment preferred. * Experience applying published healthcare guidelines such as CMS regulations and coding guidelines to healthcare claims data, Recovery audit experience a plus preferred Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. HMS Irving TX

Insurance Claims Auditor

Pacific Dental Services