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Insurance Claims Examiner, Auditor
2 months ago
Job Summary
Pacific Dental Services is seeking a highly skilled and detail-oriented Auditor, Insurance Claims to join our team. As an Auditor, Insurance Claims, you will play a critical role in ensuring accurate and maximum reimbursement for patient treatment from insurance carriers.
Key Responsibilities
- Claims Adjudication: Read and analyze Explanation of Benefits (EOBs) and make proper adjustments according to Pacific Dental Services' claims processing criteria.
- Appeals and Rebuttals: Send appeals to insurance carriers with justification for why dental treatment should be paid.
- Account Auditing: Audit accounts to ensure proper fees have been posted.
- Collaboration and Communication: Work with the Central Business Office (CBO) team to maximize office collections and minimize adjustments.
- Process Improvement: Communicate issues and suggestions to improve processes.
- Compliance: Ensure compliance with Company policies as well as State, Federal, and other regulatory bodies.
- Professional Development: Participate in meetings as required and maintain an appropriate professional appearance and demeanor in accordance with Company policy.
Requirements
- Education: Equivalent to high school diploma or general education degree (GED).
- Experience: 2-4 years of related experience in the dental field.
Preferred Qualifications
- EPIC Knowledge: Familiarity with EPIC systems.
- Education and Experience: Bachelor's degree and 3 to 5 years of related experience.
- Claims Auditing Experience: Prior experience as a claims auditor within a group practice environment.
Knowledge, Skills, and Abilities
- Multi-Tasking: Ability to multi-task effectively without compromising the quality of work.
- Communication: Excellent interpersonal, oral, and written communication skills.
- Attention to Detail: Detail-oriented, organized, process-focused, problem-solver, proactive, ambitious, customer-service-focused.
- Decision-Making: Ability to draw conclusions and make independent decisions with limited information.
- Problem-Solving: Ability to respond to common inquiries from customers, staff, regulatory agencies, vendors, and other members of the business community.
- Teamwork: Self-motivated, reliable individual capable of working independently as well as part of a team.
- Analytical Skills: Problem-solving skills to gather and analyze information to identify and resolve problems in a timely manner.
- Research and Analysis: Analytical skills to synthesize complex or diverse information.
- Collaboration: Actively share ideas in a constructive and positive manner by listening to and objectively considering ideas and suggestions from others.
Benefits
- Medical, Dental, and Vision Insurance
- Paid Time Off
- Tuition Reimbursement
- 401K
- Paid Time to Volunteer in the Community
Pacific Dental Services is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.
