Revenue Cycle Analyst- Remote
Affiliate: American Dental Partners Inc.
Location: 401 Edgewater Drive, Suite 430, Wakefield, MA
The Revenue Cycle Analyst is responsible for the timely processing and follow-up on claims submitted to insurance companies and other entities for payment. The Revenue Cycle Analyst analyzes and reviews dental insurance claims for accuracy, completeness, and eligibility. Key elements of these responsibilities include reviewing claims for eligibility to be reimbursed, maintaining updated records and preparing required documentation, assisting in controlling the cost of processing claims, and contacting policyholders about claims to gather information required for claim processing. The Analyst is also responsible for performing in-depth review of claims to determine appropriate actions to maximize insurance reimbursement.
- Read, evaluate, and analyze dental Explanation of Benefits (EOB) for accuracy and determination of appropriate follow up actions with insurance companies.
- Analyze dental records and other applicable information for determination of appropriate appeal process on denied or partially paid claims.
- Responsible for providing research and root cause analysis for claim remediation.
- Use outlined documentation in dental billing system for tracking processes and follow up needed.
- Submit electronic or hard copy dental and/or medical claims, on a timely basis to insurance companies for processing.
- Review remittance advices for payment errors, denials, and underpayments and overpayments. Follow up with insurance companies, payer relations specialists or credentialing teams, as appropriate.
- Follow up on unpaid and/or partially paid claims within standard billing cycle time frames.
- Identify and bill secondary or tertiary insurances.
- Answer all insurance company telephone inquiries pertaining to assigned accounts.
- Identifying and correcting billing errors and resubmitting claims to insurance carriers.
- Update the billing system with changes to insurance information and refile claim(s) to correct insurance or patient. Make notes in the claim filing tab as well as the resource tab as to action taken.
- Research the accuracy of patient balances, including resolution of outstanding claims, determine that the patient has received the appropriate correspondence regarding his/her account, make patient calls for balances above certain thresholds, turn over accounts to collection agency with appropriate documentation, review collection agency invoices for accuracy/correct office assignment, monitor collection folders for direct pays, correct account addresses based on USPS files.
- Perform other duties as assigned.
- Minimum of two to three years’ experience in dental insurance billing and collection.
- Proficiency with MS Office and Excel.
- Knowledge of a variety of dental billing systems preferred.
- Knowledge of dental insurance online systems as well as online status/ eligibility inquiry sites preferred.
- Knowledge of how to file claims and attachments through a clearinghouse.
- Knowledge of general dental insurance guidelines (limitations and exclusions) a plus.
- Excellent analytical skills, solutions orientated.
- Ability to handle sensitive material confidentially.
- Provides explanations and interpretations within area of expertise.
- Strong written and verbal communication skills.
- Ability to work independently.
AMDPI offers a competitive salary and excellent benefit package including a 401k, health insurance and a professional work environment. To learn more about American Dental Partners please visit our homepage at www.amdpi.com.
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