Regional Billing Specialist

Position Summary
The Regional Billing Specialist performs a variety of complex tasks related to the coordination of third and first party reimbursement to MCDC. This position works closely with Regional Managers and Office Managers in the dental centers to ensure accurate and timely reimbursement to MCDC for services provided. Ensuring compliance with third party payer requirements is required in all facets of this role.
Typical Duties and Responsibilities
Serves as a resource to dental center staff by answering questions, responding to email inquiries, assisting with problems, and providing training as necessary
Coordinates end of day procedures with dental centers as it relates to creating charges, claims and payment posting; communicates any challenges or issues identified to manager
Reviews and resolves issues related to claim generations, clean claim ratios, rejected, and denied billings
Determines the accuracy of charge capture, missing charges, late charges, covered and non-covered charges
Resolves all claim rejections identified through the front-end clearing house edits
Identify trends that may have impact on operations and communicate to manager as appropriate
Maintains ownership for the regional AR Aging and keeping it within defined goals, for both patient balances and third party insurance balances
Researches and resolves all denials related to assigned region?s claims
Identify and resolve insurance claims that are not current
Coordinates the generation and distribution of patient statements for outstanding account balances
Generate outbound phone calls to responsible parties in the effort to collect unpaid account balances
Functions as a back-up for payment posting to patient ledgers
May assist with dentist credentialing setup with insurance companies for reimbursement
Produce Month End reports for financial reporting
Researches reimbursement guidelines/requirements changes, interprets updates, and coordinates subsequent reimbursement policy and procedure changes to assure compliance
Participates in the development of policies and procedures and recommends action plans based on data interpretation and recommends system changes, as appropriate
Develops, updates, maintains and distributes excel spreadsheets as requested by directors and supervisors. Access database utilized for excel spreadsheets
Other duties as assigned
Knowledge, Skills, Abilities
Effective communication skills, both verbal and non-verbal, in a decentralized setting
Ability to maintain professional demeanor at all times
Ability to maintain outgoing, friendly attitude with patients, staff, and providers in high pressure situations
Ability to work effectively in a fast paced environment with interruptions
Ability to meet deadlines
Ability to work unsupervised
Familiar with business machines (calculator, fax, copier, scanner, credit card terminal, multiple line phone sets, etc.)
Experience with facilitation, problem solving, and presentation skills
Leadership qualities (professionalism, discretion, integrity, honesty, and dedication)
Job Specification
High school diploma or equivalent required
Associates degree in healthcare / health services or finance / accounting is preferred
A minimum of five years of medical billing processing experience is required, including claims submission, clearinghouse processing, payment posting, denials management, working AR aging and collections, and credentialing
Experience with governmental payers (Medicaid, Medicare) and compliance regulations is required
Must possess above average knowledge/experience using a computer and software, specifically Microsoft Office Suite including Excel, Word & Outlook. Experience with Dentrix extremely beneficial
Experience in a multi-entity organization is a plus

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