Auditor, Insurance Claims

About the role

The primary purpose and function of the Auditor, Insurance Claims is to adjudicate, re-bill and rebut insurance claims in order to ensure accurate and maximum reimbursement for patient treatment from insurance carriers.

Responsibilities

• Read and analyze EOB's and make proper adjustments according to PDS claims processing criteria
• Sends appeals to insurance carriers with justification as to why dental treatment should be paid
• Audit accounts to ensure proper fees have been posted
• Works with CBO team to maximize office collections and minimize adjustments
• Communicate issues and suggestions to improve processes
• Ensure compliance with Company policies as well as State, Federal and other regulatory bodies
• Participate in meetings as required
• Maintain an appropriate professional appearance and demeanor in accordance with Company policy
• Other duties as assigned by management

Requirements

• Equivalent to high school diploma or general education degree (GED)
• 2-4 Years of related experience in the dental field

Qualifications

• EPIC knowledge (preferred)
• Bachelor's Degree and 3 to 5 years of related experience (preferred)
• Prior experience as a claims auditor within a group practice environment (preferred)

Skills

• Ability to multi-task effectively without compromising the quality of the work
• Excellent interpersonal, oral and written communication skills
• Detail oriented, organized, process focused, problem solver, proactive, ambitious, customer service focused
• Ability to draw conclusions and make independent decisions with limited information
• Ability to respond to common inquiries from customers, staff, regulatory agencies, vendors, and other members of the business community
• Self-motivated, reliable individual capable of working independently as well as part of a team
• Problem solving skills to gather & analyze information in order to identify and resolve problems in a timely manner arrive at valid conclusions, recommendations, and plans of action
• Analytical skills to synthesize complex or diverse information. Ability to research information and analyze data to arrive at valid conclusions, recommendations, and plans of action
• Actively share ideas in a constructive and positive manner by listening to and objectively considering ideas and suggestions from others

Benefits

• Medical, dental, and vision insurance
• Paid time off
• Tuition Reimbursement
• 401K
• Paid time to volunteer in your local community

Pay

$22.00-$29.80 / Hourly