Regional Billing Specialist

Michigan Community Dental Clinics Kentwood , MI 49508

Posted 2 months ago

Position Summary

The Regional Billing Specialist performs a variety of complex tasks related to the coordination of third and first party reimbursement to MCDC. This position works closely with Regional Managers and Office Managers in the dental centers to ensure accurate and timely reimbursement to MCDC for services provided. Ensuring compliance with third party payer requirements is required in all facets of this role.

Typical Duties and Responsibilities

  • Serves as a resource to dental center staff by answering questions, responding to email inquiries, assisting with problems, and providing training as necessary

  • Coordinates end of day procedures with dental centers as it relates to creating charges, claims and payment posting; communicates any challenges or issues identified to manager

  • Reviews and resolves issues related to claim generations, clean claim ratios, rejected, and denied billings

  • Determines the accuracy of charge capture, missing charges, late charges, covered and non-covered charges

  • Resolves all claim rejections identified through the front-end clearing house edits

  • Identify trends that may have impact on operations and communicate to manager as appropriate

  • Maintains ownership for the regional AR Aging and keeping it within defined goals, for both patient balances and third party insurance balances

  • Researches and resolves all denials related to assigned region?s claims

  • Identify and resolve insurance claims that are not current

  • Coordinates the generation and distribution of patient statements for outstanding account balances

  • Generate outbound phone calls to responsible parties in the effort to collect unpaid account balances

  • Functions as a back-up for payment posting to patient ledgers

  • May assist with dentist credentialing setup with insurance companies for reimbursement

  • Produce Month End reports for financial reporting

  • Researches reimbursement guidelines/requirements changes, interprets updates, and coordinates subsequent reimbursement policy and procedure changes to assure compliance

  • Participates in the development of policies and procedures and recommends action plans based on data interpretation and recommends system changes, as appropriate

  • Develops, updates, maintains and distributes excel spreadsheets as requested by directors and supervisors. Access database utilized for excel spreadsheets

  • Other duties as assigned

Knowledge, Skills, Abilities

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  • Effective communication skills, both verbal and non-verbal, in a decentralized setting

  • Ability to maintain professional demeanor at all times

  • Ability to maintain outgoing, friendly attitude with patients, staff, and providers in high pressure situations

  • Ability to work effectively in a fast paced environment with interruptions

  • Ability to meet deadlines

  • Ability to work unsupervised

  • Familiar with business machines (calculator, fax, copier, scanner, credit card terminal, multiple line phone sets, etc.)

  • Experience with facilitation, problem solving, and presentation skills

  • Leadership qualities (professionalism, discretion, integrity, honesty, and dedication)

Job Specification

  • High school diploma or equivalent required

  • Associates degree in healthcare / health services or finance / accounting is preferred

  • A minimum of five years of medical billing processing experience is required, including claims submission, clearinghouse processing, payment posting, denials management, working AR aging and collections, and credentialing

  • Experience with governmental payers (Medicaid, Medicare) and compliance regulations is required

  • Must possess above average knowledge/experience using a computer and software, specifically Microsoft Office Suite including Excel, Word & Outlook. Experience with Dentrix extremely beneficial

  • Experience in a multi-entity organization is a plus

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Regional Billing Specialist

Michigan Community Dental Clinics