Revenue Cycle Specialist Job at Pure Dental Brands
Revenue Cycle Specialist – Pure Dental Brands – St. Petersburg, FL
Who are we?
Pure Dental Brands is a Dental Service Organization (DSO) supporting 45+ family and specialty offices in seven states throughout the US. Our team members make a difference each day. Whether they are in one of our practices treating our patients or at the Service Center supporting our team members, their contributions matter. The Revenue Cycle Management department implements and promotes consistent revenue integrity practices in compliance with state and federal guidelines.
Who are we looking for?
We are seeking a new Revenue Cycle Specialist team member who is motivated, driven, extremely detailed oriented, organized, and serves as a Subject Matter Expert to optimize reimbursement by ensuring correct processes are being followed in order to achieve KPI and Best Practice benchmarks. The Revenue Cycle Specialist will be responsible for the completeness of all claim-related issues in accordance with established company protocols. As such, the Revenue Cycle Analyst must have a strong working knowledge of the entire Revenue Cycle process which includes Appointment Scheduling, Insurance Verification, Charge Capture, Claim Submission, Adjudication, Payment Posting, Denial Management, Claim Appeals, Adjustments/Write-Offs, Credit Balances/Refunds, Patient Responsibility, Collections, and Reporting.
Major Role Responsibilities:
- Audit claim submissions of prior day to ensure all claims were submitted to Clearinghouse.
- Daily review of claim rejection and validation errors; correct claim errors or contact the practice, to ensure claims are submitted to the Clearinghouse in a timely manner. Track validation errors and provide monthly report to RC Manager in order to make necessary changes to increase “clean claims rate”.
- Follow-up on all open claims until full payment has been received by the Payer and Patient based on contractual fee schedules, or final claim resolution.
- Initiate the accurate and timely processing of all secondary claims, as needed.
- Work denied claims and resubmit claims for reimbursement to the insurance companies for appropriate reimbursement; contest charges that are not paid or underpaid with the insurance carrier. Access available third party and governmental on-line services and/or websites to obtain current carrier guidelines, verify eligibility, and re-file claims, if necessary. If claim is denied, ensure correct denial code is used.
- Begin claim appeals according to payer specifics, timely-filing guidelines; reviews clinical documentation for appeals and composes detailed formal appeal letters for payment or contacts provider for appeals letter.
- Retrieve and submit appropriate dental record documentation based on third party request.
- Audit patient accounts prior to appointment to ensure patient balance is correct; make adjustments, if needed.
- Audit patient accounts prior to issuing refunds. Ensure balances and ledgers are accurate prior to issuing patient or insurance refunds.
- Adjustments/Write-Offs: ensure policies are being followed according to company guidelines; audit accounts prior to making any adjustments or write-off; ensure correct adjustment or write-off codes are used.
- Audit patient accounts prior to submitting monthly patient statements to ensure balances and statements are accurate; follow-up on patient accounts.
- Submit delinquent patient accounts to collection agency; if payments are made by patients, ensure correct process is followed based on company guidelines.
- Monthly Reports: provide monthly AR analysis and trend reporting to RC Manager.
Requirements/Qualifications:
- 5+ years Revenue Cycle Management experience, preferably in a Dental environment
- Dentrix experience preferred
- Payment Posting experience preferred
- HS Diploma
- Knowledge of Medicaid/PPO/HMO dental insurance plans and networks a plus
- Ability to work independently and follow through on tasks
- Strong team player, analytical, critical thinking and problem-solving skills
We Have What Makes You Smile - Working with Pure Dental Brands, you will enjoy:
- Competitive compensation based on experience
- Paid time off program
- Paid holidays
- 401K with company match
- Full benefits to include medical (3 plans to choose from), vision and free dental insurance.
- Free life insurance with the ability to purchase more for self and dependents
- Voluntary coverage available for Short Term and Long Term Disability
- Flexible Spending Accounts and Health Savings Accounts
- Pet Insurance through Nationwide Insurance and other voluntary programs
- Award winning worksite wellness program
- Opportunities to connect with your community through charity initiatives
- Strong and high-functioning team to spend your work days with
- Team work oriented culture
- Small team environment
If the time is right for you to consider a new opportunity, check us out!
www.puredentalbrands.com
#lovewhereyouwork
Equal Opportunity Employer/Drug Free Workplace
Opportunities for all through our Power of Diversity Program
#AARP Pledge Signer
#Veteran's Hiring Pledge
www.puredentalbrands.com
#lovewhereyouwork
Equal Opportunity Employer/Drug Free Workplace
Opportunities for all through our Power of Diversity Program
#AARP Pledge Signer
#Veteran's Hiring Pledge
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