[Hiring] Claims Coordinator @Lightwave Dental

Role Description

Come join us at CarolinasDentist in Asheville where we provide positively-different dentistry! We are a hardworking, fun, outgoing team, who strive to give our patients the best experience all while maintaining an upbeat, yet relaxing atmosphere. We are up to date on all the latest technology and offer both general and cosmetic dentistry including Invisalign. We are looking for an energetic, self-driven team member to join our growing practice.

The Claims Coordinator ensures accuracy and timely filing for all dental claims for assigned office and reports problems and issues on follow up report to dental office. Reviews Accounts Receivable reports on assigned rotation for all offices, following up on outstanding insurance claims and balances; working problem EOBs, denials, and processing appeals as needed.

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.
• Sends 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.
• Calls and follows up with insurance companies on claims issues and non-payments.
• Maintains and completes all appeals and requests from insurance companies.
• Reviews returned EOBs:
• Denials - manages info needed for appealing claims.
• Denials - manages info needed for missing information or attachments.
• Corrected claims and/or retractions.
• Tracks all outstanding insurance balances by category and reports to OM when completed.

Administrative Responsibilities:

• 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.

Qualifications

• Previous experience in dental office administration, dental billing, or insurance claims processing is highly beneficial.
• 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.

Benefits

• Competitive Pay: Receive pay that matches your experience and performance.
• Comprehensive Insurance: Enjoy peace of mind with health, dental, and vision coverage.
• Future Planning: Secure your financial future with our 401k retirement savings plan.
• Time for You: Paid time off and holidays to recharge.
• Growth and Learning: Unlock your potential with opportunities for professional development and growth.