Revenue Cycle Management Specialist
2 weeks ago
Overview:
The Revenue Cycle Management Specialist is responsible for overseeing financial processes that occur outside the direct patient interaction, providing essential support to practice personnel from a centralized processing hub.
This role involves offering expertise and guidance to affiliated practice teams to enhance participation in Dental commercial insurance and Dental Medicaid, ensuring efficient and timely follow-up on accounts receivable from both insurance providers and patients.
Focused training and ongoing support are provided to practice staff and other support teams to ensure proficiency in plan management, revenue optimization, and accurate receivable documentation.
Responsibilities:
Key Duties and
Responsibilities:
On a daily basis, or as directed, process insurance claims in batches for designated practices.
Additionally, resolve all claim-related issues through to clearinghouse resolution and confirmation of receipt by the payer. Analyze and manage exceptions arising from payment postings.
Handle adjustments in accordance with established policies.
Respond promptly to receivable inquiries from field teams, demonstrating a thorough understanding of plan policies and all aspects of the revenue cycle.
Responsibilities include but are not limited to:
Enrollment, Eligibility & Verification, Claims Processing, Payment and Adjustment Posting, Insurance and Patient Accounts Receivable management.
Troubleshoot and resolve practice-related issues concerning plan policies and coverage; Dentrix and technological interfaces.
Provide appropriate support alongside other team members.
Act as the primary contact for practices regarding receivables managed by external vendors.
Serve as a liaison for practices requiring on-site assistance.
Monitor issues until resolution.
Analyze outstanding patient balances, adhering to assigned policy steps including monthly batch statement processing, sending collection letters, and coordinating with external collection agencies when necessary.
Investigate credit balances and recommend resolutions to the respective practices.Stay informed about all policy and coverage changes, including reimbursement regulations and the laws governing billing and collection activities.
Demonstrate the ability to work both independently and collaboratively within a team setting.Document all daily tasks as well as practice-related communications in Sales Force. Perform additional duties as new opportunities arise or are assigned.
Qualifications:
Qualifications include the ability to interpret and effectively communicate insurance regulations.
Excellent verbal and written communication skills are essential.
Ability to conduct telephone, in-person, and/or web-based training sessions.
Strong problem-solving abilities.
Well-organized, accurate, and detail-oriented.
Adaptable; able to adjust work schedules to meet changing work environments and manage competing demands.
Skilled in prioritizing, planning work activities, and developing actionable plans.
Proficient in all Microsoft Office applications.
Education and Experience Requirements:
An associate's degree is required, with a bachelor's degree preferred.
A minimum of five years of experience in commercial insurance or Medicaid is preferred.
Computer Skills:
Proficiency in a Microsoft Windows environment.
Experience with dental or medical software; familiarity with Dentrix and/or EagleSoft is preferred.
Core Competencies:
To succeed in this role, an individual should demonstrate the following competencies:
A strong customer service orientation.Ability to assess the developmental needs of affiliated auxiliary practice staff.
Knowledge of accounting policies and practices to understand the impact of outstanding receivables (debit and credit). Strong skills in interpersonal communication, analysis, critical thinking, attention to detail, and multitasking are essential.
Excellent verbal and written communication skills.Ability to work independently and collaboratively within a team environment.
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