Dental Coder and Treatment Plan Coordinator

3 weeks ago

Los Angeles, United States APLA Health Full time
Job Details

Job Location
APLA Health Dental Clinic, Downtown Los Angeles - Los Angeles, CA

Position Type
Full Time

Education Level
High School

Salary Range
$26.80 - $31.39 Hourly

Travel Percentage
None

Job Shift
Day: 8am - 5pm

Job Category
Admin - Clerical

Description

POSITION SUMMARY:

This position is under the direction of the Dental Director, Clinic Director, and Dental Operations Manager. The Dental Coder and Treatment Plan Coordinator is responsible for ensuring all encounters have correct information prior to being sent for billing. This is a daily function and applies to the multiple dental offices. The position also requires oversight on patients' treatment plans and referrals.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Registration information
    • Ensure all patient registration information is collected and properly scanned. Review accounts and train front office staff if necessary on registration requirements.
    • Provider telephone or in-person new patient registration to ensure all paperwork is appropriately completed.
  • Insurance Verification
    • Oversee that medi-cal or insurances are reviewed, confirmed, and documented.
    • Provide documentation that insurances are checked for patients reporting no coverage.
    • For uninsured patients that may be eligible for insurance, oversee the referral to the enrollment staff.
  • Sliding Fee Application and Income Verification -
    • Manage and review all Sliding Fee Application
    • Coordinate with the enrollment team for patients who participate in other APLA Health & Wellness departments.
    • Discuss and confirm with patients their understanding of the Sliding Fee Application and potential fees associated with dental services.
  • Appointment Workflow
    • Review all appointment visits and confirm cases are correctly attached properly.
    • Oversee the front office staff attachment of cases and ensure these are correctly added prior to the provider locking the progress note.
    • Confirm appropriate billing notes are attached and added properly.
  • CPT and ICD coding
    • Review the CPT and ICD-10 coding from Dental Examination Module, Progress note, and on the patient encounters within 24-48 hours of visit.
    • Understand what different insurances will cover and what is an uncovered benefit. This may be based on the code itself, the diagnosis for the treatment, or the timing on when the code is used.
  • Treatment Planning Review
    • Coordinate any fees and costs with patients associated with treatment plans.
  • Referral Process
    • Complete DHSP specialty referrals and provide timely follow-up with patients.
  • Prosthodontic Scheduling
    • Review actions and requirements and justifications.
    • Confirm justification approval prior to scheduling
  • External Lab Invoices and Communication
    • Assemble and review all external lab invoices. Communicate with the labs on outstanding invoices and payments. Review and submit payment requests to the fiscal department.
  • Liaison to Billing and Fiscal Departments -
    • Establish open communications with the fiscal and billing department. Answer any questions they have on codes and dental related billing challenges. Provide feedback and timely responses as needed.
  • Medical Records -
    • Complete and document ROI requests and subpoenas. Communicate with the Compliance Department on records releases and proper process to document the release of information.
  • Support
    • Support oversight with Dental Director and Dental Operations Manager. Provide all dental staff the support that is required to operate the dental clinic.

OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.

Qualifications

REQUIREMENTS:

Training and Experience:
  • AA Degree and 3 years in the administrative side of a clinical practice OR High school diploma/GED and 3 years of dental billing experience.
  • Applied knowledge of ADA procedures and codes
  • Knowledge of the principles and practice of modern dentistry
  • Experience working with multiple benefits coverage programs, including private insurance and government programs
  • Experience working in a Federally Qualified Health Center preferred
  • Bilingual English/Spanish preferred

Knowledge of:
  • Advanced computer skills including the Microsoft Office suite
  • Clinic/health care operations management
  • HIV disease, and other health disparities and comorbidities
  • HIPAA and OSHA guidelines
  • eClinicalWorks or similar electronic health record system
  • Managed care eligibility and authorization process
  • Dental terminology; current ICD and CPT coding
  • Healthcare billing processes and insurance plans (Medicaid, Medicare, and private/commercial plans; dental preferred)

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper.

SPECIAL REQUIREMENTS:

Must possess a valid California driver's license; proof of auto liability insurance; and have the use of a personal vehicle for work related purposes.

COVID vaccination and booster required or medical/religious exemption.

Equal Opportunity Employer: minority/female/transgender/disability/veteran.

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