Billing Specialist Dental

About the role

The Billing Specialist Dental is responsible for the patient registration process, insurance verification, and financial arrangement issues at the dental clinic. This position verifies third-party payer accounts, pre-authorization, and/or pre-certification requirements. The Dental Billing Specialist handles all dental billing functions, subsequent Medicaid/Private payer audits, and assists patients with billing questions, insurance inquiries, and alternative payment plans.

The role involves interfacing with private payers or their designees (such as EviCore and Navinet) to obtain authorization for antepartum imaging, diagnostic testing, and lab studies, and facilitates physician-to-physician peer reviews of questionable cases. Responsibilities include assigning appropriate CPT and ICD-10 codes, collecting quality statistical information, ensuring timely follow-up and processing of accounts, and performing charge data reconciliation for all dental accounts. The position also supports data collection for statistical and financial analysis, collaborates with dental team members, and provides quality customer service.

This role supports organizational goals through performance improvement efforts and a commitment to teamwork and cooperation.

Responsibilities

• Manage patient registration, insurance verification, and financial arrangements.
• Verify third-party payer accounts, pre-authorization, and pre-certification requirements.
• Handle all dental billing functions and subsequent Medicaid/Private payer audits.
• Assist patients with billing questions, insurance inquiries, and alternative payment plans.
• Interface with private payers or their designees (e.g., EviCore, Navinet) to obtain authorizations for antepartum imaging, diagnostic testing, and lab studies.
• Facilitate physician-to-physician peer reviews of questionable cases.
• Assign appropriate CPT and ICD-10 codes.
• Collect and maintain quality statistical information.
• Ensure timely follow-up and processing of all accounts.
• Perform charge data reconciliation for dental accounts.
• Collect data for statistical and financial analysis.
• Collaborate with dental team members, including providers, to deliver quality customer service.
• Participate in performance improvement efforts and demonstrate commitment to teamwork.

Requirements

• High School diploma or equivalent required; Associate’s degree or higher preferred.
• Ability to read, write, and speak English required; bilingual preferred.
• 5 years of prior experience in hospital/professional billing, insurance, or a related healthcare field.
• Minimum of 1 year of lead experience, either officially or demonstrated through prior examples.
• Excellent computer skills and working knowledge of medical terminology.
• Proficiency in Microsoft Windows Office applications and data entry functions.

Work Environment

• Potential exposure to hazards and risks of a hospital environment, including infectious diseases and hazardous substances.
• Physical demands include reaching, stooping, kneeling, and crouching for approximately 25% of the workday.
• Frequent lifting of 25-30 pounds; occasional lifting of 50-100 pounds with assistance.

This position reports to department leadership.

Benefits

• Generous Paid Time Off (PTO).
• Medical, prescription drug, dental, and vision insurance.
• Retirement plans with employer contributions.
• Short-term and long-term disability coverage.
• Life and accidental death & dismemberment insurance.
• Tuition reimbursement for educational goals.
• Flexible Spending Accounts (FSAs) for healthcare and dependent care.
• Wellness programs.
• Voluntary benefits, including pet insurance.

Benefits offerings may vary based on position and are subject to eligibility requirements.