Accounts Receivable Specialist (Oral Surgery)

Responsibilities

• Investigate, appeal, and resolve denied or rejected claims by insurance payors.
• Work with insurance companies to clarify discrepancies and ensure proper reimbursement.
• Review and assess Explanation of Benefits (EOBs) at the claim level to determine issues.
• Determine root cause of any billing related or claim submission issues to prevent recurrence.
• Make corrections to claims based on denials and rebill utilizing standardized process and procedures.
• Follow up with unresolved claims through system resources, clearinghouse, payer portal or call to the payor, when necessary.
• Assess whether an appeal is required for a claim denial.
• Track appeals to ensure timely payment and resolution.
• Spot recurring patterns in denials and report them to management for further analysis and action.
• Effectively communicate both verbally and in writing with team members, payors, patients, and other relevant parties.
• Keep up to date with internal processes, industry standards, and government regulations relevant to denial management to ensure compliance and best practices.
• Participate in or take on special projects or additional duties as required by the team or management.
• Maintain high performance metrics, meeting or exceeding required accounts per day to meet HighFive and provider’s expectations.
• Achieve department goals for net collection rates and the resolution of denied claims, including those successfully paid or overturned.

Requirements

• Oral Surgery billing experience required.
• Denial/Claim OR AR Experience with TMJ (temporomandibular joint/orthognathic surgery).
• High school diploma or equivalent; associate or bachelor’s degree in healthcare, business, or a related field preferred.
• Minimum of 2 years of experience in healthcare billing and accounts receivable.
• Knowledge of medical insurance plans, billing procedures, and healthcare reimbursement processes.
• Proficiency with Electronic Health Record (EHR) systems and billing software.
• Dental billing experience preferred but not required.
• Working knowledge of excel and system workflows.
• Prior experience with mid or large-scale healthcare business office of 100 or more providers preferred.
• Strong attention to detail with the ability to accurately review and process claims.
• Excellent communication and problem-solving skills.
• Ability to work independently and manage multiple tasks simultaneously.
• Knowledge of HIPAA and other healthcare compliance regulations.