Dental Claims Resolution Specialist

About the role

Our organization operates a growing network of dental practices across New York State and New Jersey. We're looking for a detail-oriented, analytical Dental Claims Resolution Specialist to join our centralized Revenue Cycle Management (RCM) team. In this role, you'll take ownership of outstanding dental insurance claims across multiple practice locations - researching denials and rejections, resolving underpayments and suspended credits, reconciling insurance payments, and working directly with insurance carriers and practice teams to keep accounts receivable clean and current.

Responsibilities

• Review, research, and resolve outstanding, denied, rejected, and underpaid dental insurance claims across multiple practice locations.
• Investigate suspended credits and payments that have not been properly attached to a patient account or claim, tracing insurance remittance information back to the correct patient encounter.
• Compare insurance EOBs and ERAs against payments posted in the practice management system to identify and correct discrepancies.
• Review completed procedures that were not attached to or billed on an insurance claim and take the necessary steps to ensure billable services are properly submitted.
• Prepare and submit corrected claims, reconsiderations, and formal appeals with appropriate supporting documentation while tracking claims through final resolution and within applicable timely filing deadlines.
• Contact Delta Dental, Medicaid, Medicaid Managed Care plans, commercial dental payers, and other insurance carriers through phone, payer portals, and clearinghouse tools such as DentalXchange.
• Review AR aging reports and prioritize follow-up on high-dollar and aged claims to minimize outstanding balances and potential write-offs.
• Verify patient eligibility, insurance coverage, and benefit information as needed to support claim resolution and prevent recurring issues.
• Monitor denial and rejection patterns across payers and locations and communicate opportunities to improve front-end processes, coding, or documentation.
• Partner with front-office and clinical teams to resolve coding, documentation, data-entry, or scheduling issues that may be delaying claim payment.
• Keep thorough and accurate notes on claim status, research, communication, and resolution steps within the practice management system.
• Assist with month-end and period-end reporting related to suspended credits, unresolved claims, and aged receivables, including spreadsheet-based payment reconciliations.
• Follow HIPAA requirements and applicable New York State insurance regulations when handling patient, claims, and payment information.
• Assist with internal and external audits involving insurance claims and payment posting as needed.

Requirements

• High school diploma or equivalent.
• Minimum 2 years of experience in dental or medical insurance claims, billing, or accounts receivable follow-up.
• Working knowledge of dental insurance claim processes, EOB/ERA interpretation, and CDT procedure codes.
• Experience with dental or medical practice management software and insurance clearinghouses.
• Strong Microsoft Excel skills, including the ability to work with pivot tables and reconcile data from multiple sources.
• Excellent attention to detail and strong analytical and problem-solving skills.
• Ability to trace discrepancies back to their root cause across multiple documents and systems.
• Strong written and verbal communication skills.
• Ability to manage a high volume of claims across multiple practice locations while meeting deadlines.

Preferred Qualifications

• Associate's degree in healthcare administration, business, or a related field.
• Prior experience working in a multi-location dental service organization (DSO) or group dental practice.
• Experience with New York State and New Jersey Medicaid Managed Care dental plans.

Pay

$21-$24/hour (commensurate with experience)

Schedule

Full-Time | Monday-Friday 8-hour shifts | On-site in Monsey, NY

Benefits

• Annual Reviews & Career Growth Opportunities
• Supportive, collaborative team environment
• Opportunity to work across a growing multi-practice dental organization
• Exposure to a wide range of dental insurance carriers and claims situations
• Opportunities to develop your knowledge of dental revenue cycle management