The Dental Billing Specialist ensures accurate and timely management of accounts receivable by processing insurance claims, resolving billing discrepancies, and securing payments, thereby supporting the financial health and operational efficiency of the dental practice.

Roles and Responsibilities:

· Generate, scrub and submit accurate dental insurance claims (electronic and paper) in a timely manner.

· Review and fix all errors/rejections/edits preventing claims from going out.

· Review and follow up on unpaid or denied claims to ensure prompt payment.

· Review undistributed insurance and patient payments for possible overpayment or incorrect posting.

· Verify dental insurance benefits and pre-authorizations when necessary.

· Work aging reports/WQs and follow up with insurance companies on overdue accounts.

· Communicate with patients regarding their balances and set up payment arrangements if needed.

· Identify and resolve billing discrepancies and appeal denied claims as needed.

· Maintain thorough documentation of all billing and collection activities.

· Collaborate with front office and clinical staff to ensure billing accuracy.

· Dental Billing Software Proficiency

· Familiarity with dental billing and practice management systems.

· Electronic Claims Processing

· Submitting and tracking electronic claims (e-claims)

· Understanding of CDT (Current Dental Terminology) coding

· Knowledge of clearinghouses and rejection handling

· Accounts Receivable Management

· Managing aged accounts

· Performing AR follow-up and reconciliation

· Dental Insurance Verification

· Verifying dental insurance eligibility and benefits

· Coordination of benefits (COB)

· Knowledge of PPO, HMO, Medicaid, and Fee-for-Service plans

· Denial & Appeal Management

· Identifying denied or underpaid claims

· Drafting and submitting appeals

· Understanding EOBs (Explanation of Benefits) and ERA (Electronic Remittance Advice)

· ICD & CDT Coding Knowledge

· Understanding of ICD-10 codes (when applicable)

· Proficient in CDT coding for dental procedures

· HIPAA Compliance

· Knowledge of privacy and security regulations in healthcare billing

· Handling of sensitive patient financial and health information

· Excel & Data Management

· Using spreadsheets for AR tracking and reporting

· Payment Reconciliation

· Matching payments to procedures and invoices