The Dental Billing Appeals Specialist is responsible for reviewing any unpaid claims from the insurance plans. The appeal specialist follows up with the insurance company after 30 days of filing. Additionally, the appeal specialist will request reconsideration for payment for any denial claims that we have supporting documentation for payment.

QUALIFICATIONS:

• Knowledgeable with Dental Coding
• Knowledgeable with Dental Medicaid and PPO claim adjudication
• Knowledgeable with Dental Benefits and Verification of Coverages
• Knowledge of legal and regulatory provisions related to collection activities.
• Skilled with computer applications and fast typing.
• Ability to communicate with internal operations, patients, and insurance companies on all collection matters in a courteous manner.
• This position may require the employee to use his/her personal vehicle to travel to different work sites during the course of the work day, which means you would need an active, valid Driver’s License.

ESSENTIAL FUNCTIONS:

• Identifies delinquent accounts, aging periods, and payment resources
• Contacting patients for additional insurance information and resubmitting dental claims to appropriate dental payer.
• Reviewing Explanation of Benefits and patient history for accurate reimbursement and discounts by contracted managed care companies.
• Research and processes all rejected claims and resubmits with corrected information.
• Assists with processing insurance & patient refunds.
• Processes insurance related correspondence and responding timely to inquiries.
• Follow up with insurance companies ensuring that claims are paid on a timely basis by monitoring aging reports and open claims reports.
• Develops relationship with key personnel at the dental payers to obtain assistance with claim reconsiderations.
• Maintains strict confidentiality
• Performs all other duties as assigned