Dental Revenue Cycle Specialist
27 days ago
Ladson
Job DescriptionDescription: Dental Revenue Cycle Specialist Job Type: Full-Time Location: Ladson, SC Position Summary The Dental Revenue Cycle Specialist plays a critical role in protecting and optimizing the financial performance of a multi-surgeon, multi-location oral surgery practice. This position is responsible for the accurate and timely management of claims submission, payment posting, accounts receivable follow-up, and payer communication to ensure maximum reimbursement and revenue integrity. This role requires strong attention to detail, analytical thinking, payer knowledge, and a proactive approach to resolving reimbursement barriers. The Revenue Cycle Specialist serves as a liaison between patients, providers, and insurance carriers to ensure accurate billing, regulatory compliance, and an exceptional patient financial experience. Key ResponsibilitiesRevenue Integrity & Claims Management • Review daily surgical schedules to ensure services are billed accurately and in accordance with documentation and payer requirements, • Prepare, scrub, and submit clean claims for medical and dental payers, • Ensure proper coding and claim set-up based on procedures, modifiers, and payer guidelines, • Monitor claim acceptance and resolve rejections promptlyPayment Posting & Reconciliation, • Accurately post insurance and patient payments, • Review and interpret Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs), • Identify contractual discrepancies and underpayments, • Reconcile payments against fee schedules and negotiated ratesAccounts Receivable & Follow-Up, • Proactively work unpaid claims and aged accounts receivable, • Identify denial trends and root causes, • Submit timely appeals with appropriate documentation, • Follow through to resolution to ensure proper reimbursementInsurance & Payer Relations, • Communicate with insurance carriers to resolve claim issues and obtain clarification on benefits and processing, • Respond to payer requests for additional documentation in a timely manner, • Maintain working knowledge of commercial, Medicare, Medicaid, and leased network plans, • Understand coordination of benefits, medical vs. dental billing, and payer-specific requirementsPatient Financial Support, • Respond to patient inquiries regarding billing and insurance processing, • Provide clear, professional communication regarding account balances and insurance activity, • Support a positive and transparent financial experienceData Accuracy & Compliance, • Enter and maintain accurate patient insurance demographics in practice management software, • Ensure compliance with HIPAA, OSHA, and internal policies, • Maintain required accuracy standards during account audits, • Adhere to all established and newly implemented RCM proceduresContinuous Improvement & Collaboration, • Identify workflow improvement opportunities to reduce denials and increase collection efficiency, • Collaborate with insurance verification, front office, and clinical teams to resolve billing barriers, • Maintain professionalism in all telephonic and written communication, • Support departmental goals related to Days in AR, Net Collection Rate, and Denial RateRequirements: Qualifications • Prior experience in dental or medical revenue cycle management required (oral surgery experience preferred), • Strong understanding of EOB interpretation, claim lifecycle, and denial management, • Knowledge of dental and medical coding preferred, • Experience with multi-location or multi-provider environments a plus, • High attention to detail and ability to manage multiple priorities, • Strong communication and problem-solving skills Expectations & Availability • This role is on-site., • Employees must attend meetings, trainings, and support on-site initiatives., • Be responsive during working hours; notify supervisors of changes promptly. Key Metrics (KPIs & SLAs) • Claim Submission: Within 48 hours of service., • Payment Posting: Within 3 business days., • AR less than 90 Days: Maintain at 10% or less., • Denial Rate: less than 5% | Rejection Rate: less than 2%, • Appeals: Submitted within 5 business days., • Refunds: Initiated within 2 days, processed in 7–10 days., • Patient Inquiries: Respond within 24 hours., • Internal/External Communication: Response required within 24 hours., • Escalations: Billing errors unresolved after 48 hours must be escalated., • Documentation: Same-day entries with proper attachments.
