JOB TITLE: Claims Specialist - Dental

BASIC JOB PURPOSE: Selects procedure and diagnosis codes based on provider documentation, enters charges into Practice Management System, handles correspondence related to patient accounts, answers patient questions about billing procedures

SUPERVISION RECEIVED: Reports to the Director of Business Services

SUPERVISION EXERCISED: None

TYPICAL PHYSICAL DEMANDS: Requires sitting for long periods of time. Working in office environment. Some bending and stretching required. Use of telephone required. Manual dexterity required for use of calculator and computer keyboard.

TYPICAL WORKING CONDITIONS: Normal office environment. May require evening and/or weekend work. Work may be stressful at times.

EXAMPLES OF DUTIES: (This list may not be all inclusive.)

  1. 1. Reviews charges entered into the Practice Management system from provider.
  2. 2. Acquires patient billing information from patients and source documents.
  3. 3. Submits claims on regular schedule to Medicare, Medicaid, insurance carriers, and other third party payers to ensure prompt payment.
  4. 4. Keeps abreast of the various insurance regulations.
  5. 5. Makes recommendations concerning accounts to be written off or turned over for collection.
  6. 6. Posts all actions related to patient’s account into computer system as permanent record.
  7. 7. Assists patients with application process for schedule of discounts program.
  8. 8. Facilitates prior authorization for dental procedures.
  9. 9. Manages Senior Millage Program, tracking and reporting.
  10. 10. Participates in professional development activities.
  11. 11. Although each position has its own unique duties and responsibilities, please refer to the policy on Job Descriptions for details that apply to every position.

PERFORMANCE REQUIREMENTS

Knowledge, Skills and Abilities:

  • Knowledge of charge entry, billing and registration policies and procedures.
  • Knowledge of insurance billing procedures.
  • Proficiency with CDT and ICD-10-CM coding manuals.
  • Knowledge of Grace Health departments and operational relationships.
  • Skill in defining problems, collecting data, interpreting billing information.
  • Skill in computer applications.
  • Ability to perform mathematical computations.
  • Ability to communicate effectively, both verbally and in writing, with patients and staff.

Education: High school diploma or GED

Experience: Three years of claims processing experience in a health care organization

Certificate/License: CPC or similar credentials preferred, although not required

ACCOMMODATION: Grace Health has the right to modify the duties and functions of the job description based on the needs of the organization.

JOB DESCRIPTION REVIEW: This job description will be reviewed and updated, if necessary, during the employee’s annual review.

FLSA: Not an exempt position