Dental Claims Processing Representative

Job Description

REQUIREMENTS

• Prior clerical experience in a healthcare or dental office setting is highly preferred
• Demonstrated experience with filing, organizing medical records, and managing documentation workflows
• Knowledge of insurance verification processes and familiarity with dental insurance plans is advantageous
• Strong understanding of medical terminology, ICD coding (ICD-9 & ICD-10), CPT coding, HCPCS codes, and medical billing procedures
• Experience working with financial software systems used for claims processing and record management
• Familiarity with Workers’ Compensation law regulations related to dental claims is a plus
• Excellent organizational skills with the ability to prioritize tasks in a fast-paced environment

RESPONSIBILITIES

• Review and process dental insurance claims, ensuring all necessary documentation is complete and accurate
• Verify insurance coverage, including Medicare, Workers’ Compensation law, and other applicable policies
• Apply appropriate medical coding such as CPT (Current Procedural Terminology), ICD-9, ICD-10, HCPCS, and DRG codes to claims for precise billing
• Conduct insurance verification procedures to confirm patient eligibility and benefits prior to claim submission
• Organize and maintain medical records, dental documentation, and filing systems for easy retrieval and audit readiness
• Collaborate with healthcare providers to clarify or obtain missing or additional medical documentation as needed
• Ensure compliance with medical billing standards and insurance regulations while processing claims efficiently
• Utilize financial software to track claim status, resolve discrepancies, and facilitate timely reimbursements

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