Revenue Cycle Specialist

Key Responsibilities

• Verify patient insurance eligibility and benefits prior to scheduled appointments.
• Review and confirm coverage details, including annual maximums, deductibles, frequency limitations, waiting periods, and coordination of benefits.
• Accurately document verified insurance benefits in the practice management system to ensure reliable financial and clinical workflows.
• Create, update, and maintain accurate insurance plans within the practice management system.
• Ensure patient plans contain correct payer information, group and policy numbers, and coverage details.
• Conduct routine audits of insurance plans to identify inaccuracies and remove outdated or duplicate records.
• Submit insurance claims daily in a timely and accurate manner.
• Manage payor portals and regularly retrieve EFTs and ERAs from insurance websites.
• Post insurance payments and contractual adjustments accurately to patient ledgers.
• Perform consistent follow-up on aged insurance claims to ensure proper reimbursement.
• Forward aged accounts to collections as appropriate and post payments received from collection agencies.
• Assist with identifying, processing, and reconciling patient refunds.
• Review clinic schedules to confirm insurance eligibility and benefits prior to patient visits.
• Collaborate with clinic teams to resolve insurance discrepancies before treatment is rendered.
• Support the development of accurate treatment estimates based on verified insurance benefits.
• Proactively identify insurance setup or eligibility issues that may result in claim denials.
• Partner with billing and accounts receivable teams to correct systemic insurance configuration issues.
• Track and analyze denial trends related to eligibility, benefit verification, or plan setup errors.
• Work closely with office managers and clinic teams to improve insurance verification and billing workflows.
• Provide guidance and training on proper insurance data entry and verification procedures.
• Communicate common insurance challenges that may impact patient billing and collections.
• Identify trends in insurance errors, eligibility issues, and claim denials that affect revenue performance.
• Recommend process and workflow improvements to enhance overall revenue cycle effectiveness.
• Participate in ongoing Revenue Cycle Management (RCM) optimization initiatives.

Qualifications

• High school diploma or equivalent
• Associate’s degree in healthcare administration, business, or related field preferred
• Two (2) years of experience in dental or healthcare revenue cycle management.
• Proficient or the ability to become proficient within 90 days in dental software.
• Strong understanding of dental insurance verification and benefit structures
• Knowledge of claims submission and insurance billing processes.
• Strong attention to detail and critical thinking skills.
• Knowledge of insurance denial management and accounts receivable follow-up preferred.