** Please note that this position will work remotely after a minimum of 6 months of onsite training in the Winter Garden, FL office **

CHC follows the CMS requirements which requires all team members to obtain a COVID-19 vaccination.

A career at Community Health Centers offers a unique opportunity to join a team that makes a real impact in our community every day, by improving individuals' health while enhancing their quality of life.

Top Reasons to work at Community Health Centers

• A great benefits package that includes healthcare coverage, paid time off, paid holidays, retirement plan, and more.
• Competitive compensation with advancement opportunities and tuition / training reimbursement.
• Awarded "Best and Brightest Companies to Work for in the Nation" in 2018, 2019, 2020, and 2021.
• Awarded "Top 100 Workplaces for Growing Families" by Orlando Sentinel.
• Modernized and attractive health centers, that patients love.

Job Summary:

The Dental Billing Representative will review all assigned claims for billing accuracy and compliance with payer policies and requirements. Responsible for filing and ensuring all third-party payer claims are paid timely. Responsible for completion of all duties and reports listed on the Billing Guidelines.

Primary Responsibilities and Specific Duties:

• Review claims for accurate CDT coding, accurate tooth number and surfaces and submit following individual dental payer guidelines.
• Reviews claims for accuracy in accordance with Medicaid and Managed Care policies.
• Reviews dental module for frequencies, x-rays and documentation required for narratives.
• Utilize dental payer portals to submit corrected claims and claims requiring X-rays and narratives.
• Transfers balances to patient's responsibility on non-covered items, benefits denied, or charges applied to the deductible.
• Researches and ensures corrections are made on denied claims due to missing or incorrect information.
• Ability to check dental insurance eligibility and review benefits, frequencies and patient history.
• Dental Payment posting along with the posting of insurance and patient refunds.
• Performs insurance collection (follow-up) function utilizing the collection system management and aging reports. As a part of this function generates and reviews aging reports to submit to insurance carriers when appropriate and in accordance with established guidelines.
• Runs paper claims when necessary and submits claims to appropriate fiscal intermediary.
• Prepares all refund paperwork for accounts payable and enters adjustments into the eClinicalWorks (eCW) System.
• Maintains current knowledge of all Medicaid policies and procedure updates.
• Self-Pay Collection:
  • Reviews and appropriately places account claims in the collection management system in eCW.
• Following collection guidelines, sends collection letters and establishes phone conversations concerning outstanding balances.
• Establishes payment arrangements with responsible parties for outstanding balances.
• Processes all returned mail according to established policy and procedure.
• Processes all incoming patient correspondence and answers all patients' questions regarding their account balance.
• Processes electronic file for monthly patient statements.
• Makes necessary adjustments to correct patient accounts for correct billing.
• Provides recommendations to Billing and Coding Manager regarding account disposition (collection agency placement, write-off discharge, etc.).
• Reports billing challenges to the Billing & Coding Manager and/or Patient AR Manager.
• Answers questions related to insurance and patient dental billing for all internal/external customers.
• Ensures accuracy of payments received from third party payers per contracts and current reimbursement rates.
• Posts contractual adjustments as required to Medicaid, HMO, PPO and other accounts per contracts and current reimbursement rates.
• Collects and posts payments and completes appropriate forms/reports and submits daily to Billing and Coding Manager and Bookkeeper.
• Performs all other duties as assigned.

Qualifications:

Education:

• High School Diploma or equivalent is required.

Experience:

• One year of dental billing and collection background and experience in a physician practice setting is required.
• Must be experienced in working with eClinicalWorks or other similar medical software products.
• Must have basic knowledge of medical terminology.
• Must have good communication and customer service skills.

Certification/Licensure:

• NA

Special Skills:

• Must understand the billing procedures for Medicare/Medicaid, Workers Compensation, HMOs, PPOs and other managed care and commercial insurance plans.
• Must have knowledge of state credit laws and regulations and generally accepted collection practices.
• Ability to read, understand, and follow oral and written instructions.
• Maintain patient confidentiality.
• Excellent communication and customer service skills.

Other requirements:

• Able to work flexible hours as needed.