Roles and Responsibilities

The Revenue Cycle Specialist is well versed and crossed trained in all areas of the revenue cycle and accustomed to working in a high-volume environment.  Key Responsibilities include:

• Performs manual and electronic posting functions for all payors/patient accounts, including cash balancing and reconciliation of bank deposits.
• Post payment corrections, payment transfers and NSF’s.
• Research and clear unapplied accounts using established identification functions/process.
• Analyzes and correct insurance account receivable and payment posting ledger and posting errors
• Reviewing patient accounts to determine and correct any discrepancies; account audits, aging AR, unapplied adjustments, resolving credit balance, unposted payments
• Ledger accuracy and account integrity
• Thoroughly research all payor recoupments and identify errors and/or opportunity to dispute and restore loss in revenue. Research and validate patient refunds prior to processing refund to patient and or state for unclaimed funds. 
• Maintains knowledge of insurance rejections/denial processing and appropriately posts information for collection and follow up activity.
• Research and follow up on all correspondence associated with assigned accounts, including EOB’s and documentation letters and generate correspondence requesting required information, when necessary
• Responsible for all aspects of follow up and collections, including making phone calls, accessing payer websites.  Identify issues or trending and provide suggestions for resolution. 
•  Accurately and thoroughly documents the pertinent collection activity performed.   Review the account information and necessary system applications to determine the next appropriate work activity.
•  Reviews investigate and resolves claims that have been rejected or denied by insurance.
• Initiates appeals and ensures all required documentation is submitted in the appeal process.  Researches all denials and follow up as necessary
•  Verify claims adjudication utilizing the appropriate resources and applications.
• Receives inbound and places outbound calls to/from insurance companies and patients to collect outstanding funds
• Answer patient billing questions and act as a resource for patient billing questions.
• Initiate telephone or letter contact to patients to obtain additional information as needed. 
• Verification of insurance benefits utilizing website, fax and phone.  Knowledge of plan types/builds and how to create within the system
• Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers.  Edit claims to meet and satisfy billing compliance guidelines for electronic claim submission. 
• Processing dental clean claims for payment by all insurance companies to ensure appropriate and timely coding, billing and collections 
• Manage and maintain assigned workload, complete reports, and resolve high priority and aged inventory.
• Responsible for meeting goals and objectives in assigned areas of revenue cycle operations
• Identifies problems or improvements within own areas, develops resourceful and alternative solutions for work improvement or problem solution
• Other duties and responsibilities as assigned by leadership

Qualifications and Education Requirements

Essential Qualifications

• Prior experience in Dental Office workflows, Revenue Cycle functions to include Scheduling, Registration, Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow up and payment posting process
• Must be knowledgeable of reimbursement/compliance process and procedures with all payors
• Experience with practice management software systems, insurance portals, clearing houses, insurance guidelines, banking reconciliation software, proficient in intermediate PC skills (MS Office—strong excel skills). Strong computer literacy, Excellent Math and problem-solving skills.  Data entry and 10-key by touch.
• Strong interpersonal and organization skills.  Ability to work within a team setting and as an individual contributor.  Excellent oral and written communication skills
• Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating procedures
• Organized work habits, accuracy, and proven attention to detail with strong analytical skills