[Hiring] Claims Coordinator @Lightwave Dental

Role Description 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 reporting 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
• 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, including knowledge of common insurance codes (e.g., CDT codes) and claim forms (e.g., ADA dental claim form)
• Detail-oriented to accurately review claims, ensure all necessary information is included, and identify any discrepancies or errors
• Strong communication skills for interacting with patients, dental providers, insurance companies, and other staff members, including both verbal and written communication skills
• Ability to effectively manage and prioritize multiple tasks, such as processing claims, following up on outstanding payments, and resolving claim disputes
• Proficiency with dental practice management software and other computer applications used for claim processing and administrative tasks is typically required
• Good customer service skills for addressing inquiries and concerns in a professional and empathetic manner
• Ability to troubleshoot issues related to claim processing, billing errors, or insurance coverage discrepancies
• Knowledge of and adherence to legal and ethical guidelines related to patient privacy (HIPAA) and billing practices is essential

Benefits

• Health and dental benefits
• 401(k)
• Holiday pay
• Paid time off

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