Claims Coordinator – CBO

Job Description

REQUIREMENTS

• Previous experience in dental office administration, dental billing, or insurance claims processing is highly beneficial
• Candidates with experience in medical claims processing may also be considered
• Familiarity with dental terminology and procedures is essential for accurately processing claims and communicating with dental providers and insurance companies
• A good understanding of dental insurance policies, coverage limitations, and claim submission procedures is necessary. This includes knowledge of common insurance codes (e.g., CDT codes) and claim forms (e.g., ADA dental claim form)
• Dental claims coordinators must be detail-oriented to accurately review claims, ensure all necessary information is included, and identify any discrepancies or errors
• Strong communication skills are important for interacting with patients, dental providers, insurance companies, and other staff members, including both verbal and written communication skills
• The ability to effectively manage and prioritize multiple tasks, such as processing claims, following up on outstanding payments, and resolving claim disputes, is crucial in this role
• Proficiency with dental practice management software and other computer applications used for claim processing and administrative tasks is typically required
• Dental claims coordinators often interact with patients regarding billing and insurance matters, so good customer service skills are important for addressing inquiries and concerns in a professional and empathetic manner
• The ability to troubleshoot issues related to claim processing, billing errors, or insurance coverage discrepancies is valuable for resolving issues efficiently and effectively
• Knowledge of and adherence to legal and ethical guidelines related to patient privacy (HIPAA) and billing practices is essential

RESPONSIBILITIES

• Reviews clinical note, x-rays, and account ledger for cohesion of information
• Creates and submits e-claims and paper claims attaching any necessary x-rays, notes, narratives, charting, etc. This includes ortho claims
• Send claims through clearing house and manages all invalid and rejected claims
• Claims should be sent out within 48 hours of the date of service
• Any account or claim issues are included on a Follow Up report to the dental office or assigned to the designated DO team member within PMS with the expectation that answers and corrections will be made within 48 hours of sending the report
• If accounts are unresolved from the dental office from the follow up report, an Urgent Weekly Report goes to the dental office
• Files corrected claims triaged from the AR Specialist based on returned problem EOBs
• Manages Accounts Receivable report on an assigned schedule, reviewing accounts for outstanding insurance claims and balances
• Calling and following up with insurance companies on claims issues and non-payments
• Maintains and completes all appeals and requests from insurance companies
• Reviewing returned EOBs:
• Denials- manages info needed for appealing claims
• Denials- manages info needed for missing information or attachments
• Corrected claims and/or retractions
• Tracking all outstanding insurance balances by category and reporting to OM when completed
• Participates in special projects and tasks as assigned
• Fills in for other Claims/AR Coordinators as needed
• Assists and conducts training of new CBO team members
• Attends and contributes to monthly meetings
• Reports to CBO-RCM with any grievances or issues

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