Revenue Cycle Specialist- Remote
Affiliate: American Dental Partners Inc.
Location: 401 Edgewater Drive, Suite 430, Wakefield, MA
The Revenue Cycle Specialist is responsible for the timely processing and follow-up on claims submitted to insurance companies and other entities for payment. The Revenue Cycle Specialist analyzes and reviews insurance claims for accuracy, completeness, and eligibility. 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 and may provide information regarding the amount of benefits. The Specialist is responsible for performing more in-depth review of claims to determine appropriate actions to recover claim payments. This position also provides leadership and ongoing guidance to other team members.
- Read, evaluate, and appropriately analyze 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.
- Review and prepare claims for electronic and hard copy billing submission.
- Responsible for providing research and root cause analysis for claim remediation.
- Standard documentation in dental billing system for tracking processes and follow up needed.
- Use pertinent data and facts to identify and solve a range of problems within area of expertise.
- Submit on a timely basis to insurance companies’ dental and medical claims for processing.
- Identify and correct billing errors and resubmit claims to insurance carriers.
- Provide review and remittance advice for payment errors, denials, and under payments.
- Follow up on unpaid claims within standard billing cycle time frames.
- Call insurance companies regarding payments and denials and to check on EOBs.
- Identify and bill secondary or tertiary insurances.
- Answer all patient or insurance company telephone inquiries pertaining to assigned accounts.
- Research and follow-up on client questions regarding statements and patient balances.
- Update the billing system with changes to insurance information and notes regarding progress as well as alerts for Operations staff to collect on co-pay, etc.
- 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.
- Review adjustment reports requiring intimate knowledge of claim filing and claim payment tabs.
- Detect payer and provider trends that are indicative of underlying coverage issues and payer issues.
- Detailed understanding of how insurance coverages are set up, including procedures and category tabs and how to adjust coverages as needed.
- Analyze the appropriateness of discount code write offs.
- Identify provider credentialing issues.
- Work with EDI Support and/or credentialing team to address and correct errors.
- Identify areas of revenue leakage and revenue opportunities and propose Improvis or operational enhancements.
- Perform other duties as assigned.
- Bachelor’s degree or equivalent experience preferred.
- Prior Supervisory or training experience preferred.
- Minimum of 5 years of experience in specialty insurance billing or collections required, including submitting and following up on claims.
- Experience in Dental, Hospital or Physician Billing and Collections preferred.
- Proficiency with MS Office and Excel.
- Knowledge of a variety of hospital, physician and/or dental billing systems required.
- Knowledge of a variety of insurance online systems as well as online status/ eligibility inquiry sites required.
- Knowledge of general insurance guidelines 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.
- Ability to multitask, this includes ability to understand multiple products and multiple levels of benefits within each project.
- Ability to communicate with leadership regarding complex insurance issues, using influence to reach desired outcome.
- Solid understanding of how to reallocate payments to procedures.
- Identify, manage and correct complex process issues.
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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