Dental Biller

1 month ago
Full-time
Mid Level
Operations
GoTo Telemed

GoTo Telemed

GoTo Telemed provides secure and convenient virtual healthcare services, allowing patients to connect with experienced clinicians nationwide through video or audio calls, while also offering integrated tools for medical professionals such as EHR integr...

Internet Software & Services

Description

  • Verify patient dental insurance eligibility and benefits prior to appointments, including deductibles, maximums, copays, frequency limits, pre-authorizations, and referral requirements.
  • Coordinate with scheduling to capture and maintain accurate patient demographic and insurance data, communicate pre-authorization and financial responsibilities to patients, and document consent in compliance with HIPAA and telehealth laws.
  • Accurately code dental procedures using CDT codes and appropriate procedure modifiers, assign ICD-10 diagnoses when applicable, and apply telehealth modifiers and correct place-of-service codes for teledentistry encounters.
  • Prepare, submit, and track electronic and print-to-mail claims within payer timeframes, maintain submission logs (submission date, claim number, status), and comply with payer-specific submission requirements.
  • Conduct systematic accounts receivable follow-up and collections for outstanding claims and patient balances (15, 30+ days), send statements, perform phone/email follow-up, and negotiate payment plans or settlements when appropriate.
  • Analyze claim denials and rejections, identify root causes, submit corrected claims and formal appeals with supporting documentation, and maintain denial-tracking reports to drive process improvements.
  • Post and reconcile insurance payments, EOBs, and patient payments to patient accounts, identify discrepancies, track write-offs and contractual adjustments, and reconcile monthly payment totals with banking records.
  • Manage print-to-mail operations for claims, patient statements, and appeals, maintain HIPAA-compliant mailing logs and tracking, and verify mailing addresses and delivery when required.
  • Generate and communicate daily, weekly, and monthly revenue cycle reports and KPIs (Days in AR, claim submission/approval rates, denial rates, collection rates, AR aging), identify trends, and recommend process improvements.

Requirements

  • High school diploma or GED required; formal training in dental billing, medical billing, healthcare administration, or related field strongly preferred.
  • Preferred certifications: Certified Professional Biller (CPB, AAPC), Certified Dental Coder (CDC, AADC), Certified Medical Reimbursement Specialist (CMRS), or RHIT.
  • Proficient with Current Dental Terminology (CDT) codes and ICD-10 coding standards; familiarity with CPT coding for applicable dental/surgical services and medical billing basics for surgical procedures billed to medical insurance.
  • Working knowledge of telehealth/teledentistry modifier requirements (95, GT, FQ, FR) and correct place-of-service coding for teledentistry encounters (POS 02 or 10).
  • Advanced proficiency with Microsoft Office (Excel, Word, Outlook) and experience with practice management/EHR systems, dental coding software/encoders, and insurance company portals/claim submission systems.
  • Strong data entry accuracy, computer literacy, and experience posting payments, reconciling EOBs, and maintaining clear audit trails for transactions.
  • Comprehensive understanding of HIPAA Privacy, Security, and Breach Notification Rules, OIG compliance (including exclusion list checks), Anti-Kickback/Stark law awareness, and state-specific telehealth/teledentistry billing regulations and CMS telehealth policies.
  • Demonstrated soft skills: exceptional attention to detail, strong written and verbal communication, problem-solving, time management, customer service orientation, organization, analytical thinking, professionalism, and adaptability.
  • Must pass HHS OIG LEIE exclusion check and standard criminal background check; HIPAA certification/training required before hire and annually; candidate must comply with periodic exclusion list re-verification and maintain any required state healthcare administrative licenses.

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