Insurance Follow-up Specialist (REMOTE)

To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ESSENTIAL JOB RESPONSIBILITIES
• The Claims Resolution / Insurance Follow-up Specialist is an essential position within the Revenue Cycle Team providing support to the Elite Dental Partners Practices to ensure claims are submitted and resolved timely in accordance with government regulations and payor guidelines.
• The Specialist is responsible for accurate and timely claims follow-up and timely claims resolution. The Specialist adheres to government regulations, payor contracts, and third-party guidelines when resolving open balances, resolving denials, and appealing claims. The incumbent is responsible for identifying and reporting inefficiencies and opportunities that enhance revenue flow, decrease denials, and minimize write-offs.
• Analyzes authorizations, claims, explanation of benefits, correspondence, payor website and/or any additional information necessary to identify the next appropriate action toward payment resolution.
• Follows government, commercial, and/or third-party payor guidelines to ensure complete and timely follow-up on open balances for assigned payors or accounts.
• Performs appeals, underpayment appeals, claim and payment disputes by following government, commercial, and third-party payor appeals guidelines or contracted terms. Utilizes payor contracts and fee schedules to perform underpayment appeals or collaborates with the practice to obtain medical necessity appeals documentation. Assists with tracking appeals outcomes.
• Contacts patients or appropriate payor representatives via phone or electronically to resolve claims and/or coordinate benefits and submits claim in the correct filing order. Works to identify other payors when possible and ensures all payors and filing order is correct in the practice management system.
• Collaborates with other Revenue Cycle Specialists and Corporate Training Teams to identify patterns and interpret denial trends. Notifies Manager when insurance plans deny services, which are covered based on the contract terms, government regulations, third party agreement or patient's benefit plan.
• Works to minimize write-offs by exhausting all resolution options and performing thorough research/review of all appropriate resources. Adjusts account or requests write- offs adhering to EDP policies and procedures.
• Reviews denial reports and makes recommendations for billing or claim submission changes based on claim denials.
• Research payor and government websites, to identify payor claim requirements required to resolve open claims.
• Collaborates with Revenue Cycle Management, Office Managers, or Providers to resolve coding related denials and submits all coding related corrected claims and/or appeals.
• Targets and reports any internal procedures or processes that may negatively impact or increase days in accounts receivable or delay claims resolution.
• Interacts with patients, government payors, and third-party payors to respond to billing requests as appropriate.
• Assists with practice or patient requests by reviewing account and providing claim information and/or claim status to requesting party.
• Meets productivity and quality standards.
• Documents using standardized note format for all patient, payor, and/or third-party follow-up and account resolution activities in the practice management system
• Remains current with trends, regulatory requirements, and business strategies related to the revenue cycle and dental practice.
• Operates in compliance with all local, state and Federal laws as well as EDP policy and procedures.
• Other duties and responsibilities as assigned
REQUIRED EDUCATION AND EXPERIENCE
• High School Diploma or equivalent; Associates or Bachelor's-Degree preferred
• At least three (3) years dental bill generation and claims processing experience
• Expertise in government, commercial and/or third-party payor claims submission, denial resolution, and appeals processes

QUALIFICATIONS
• Knowledge of dental claim requirements; Ability to interpret and apply government and third- party payor billing guidelines, claim rules, and managed care contract terms
• Knowledge of Dentrix Core and Ascend PMS systems
• Microsoft Excel creation and basic functional working knowledge
• High attention to detail and accuracy
• Ability to meet set quota expectations
• Knowledge of CDT and ICD coding systems
• Detail oriented with a high level of problem-solving skills
• Ability to work effectively within designated timeframes
• Ability to collaborate and work cohesively as part of a team
• Communicates effectively orally and in writing
• Experience with Microsoft Word and Excel

PHYSICAL REQUIREMENTS
• Sitting and typing for long periods

The above statements are intended to provide a general overview and level of work being performed by most people assigned to this job. They are not intended to be a list of all responsibilities, duties and requirements. Additional duties can be assigned as determined.

Elite Dental Partners is an Equal Opportunity Employer. We support a diverse workforce.