Description:
SUMMARY
The Dental Billing Specialist 2 is responsible for all aspects of the dental revenue cycle, including charge entry, insurance billing, payment reconciliation, accounts receivable follow up, patient financial counseling, prior authorizations, and encounter rate billing. The position also supports front office operations, maintains accurate billing records, prepares reports, and collaborates with clinical and administrative staff to ensure timely and accurate reimbursement.
PRINCIPAL ACTIVITIES & RESPONSIBILITIES
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Ensures all patient charges are accurately entered into the patient ledger and submit timely and accurate insurance claims including commercial, encounter-rate, and Tribal-specific daily claims, in accordance with payer and organizational billing requirements.
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Conducts chart audits to verify documentation, coding, and patient ledger entries are accurate, compliant, and consistent with payer, regulatory, and organizational billing requirements.
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Reconciles insurance payments, manages Dental Clinic deposits, and processes adjustments in coordination with the Finance - Accounts Receivable team.
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Provides billing related support to the Dental Front Office operations and Dental Billing staff as needed.
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Assists TRHC Dental patients access insurance coverage or financial assistance for dental services through the Oregon Health Plan, Marketplace, TRHC Sliding Scale Program, and other available resources.
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Prepares month end reports related to clinic activities.
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Monitors billing and accounts receivable reports and provides relevant information to the Revenue Cycle Manager in support of clinic operations.
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Follows up with insurance carriers on submitted claims to resolve issues, promote timely processing, and ensure accurate reimbursement.
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Provides back-up coverage for the Dental Front Office Desk Assistant as needed.
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Coordinates with the Dental Front Office Assistant on insurance capture, verification, and the maintenance of insurance coverage tables.
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Monitors fee schedules and reviews proposed updates with the Revenue Cycle Manage for presentation to the CFO and Health Services Leadership Team.
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Tracks changes to payer policies and communicates potential billing impacts to the Revenue Cycle Manager and Health Services Leadership.
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Prepares, submits, and monitors prior authorization and referral requests to support timely approvals and continuity of patient care.
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Reviews treatment plans with patients, presents available treatment options, and discusses applicable financial options.
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Maintains accurate, complete, and detailed records in accordance with departmental and organizational requirements.
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Collaborates efficiently and effectively while consistently demonstrating professionalism and maintaining positive, respectful relationships with internal teams, external partners, and Tribal members.
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Provide excellent customer service to clients and vendors of the CTCLUSI Dental Clinic and all other Health Services.
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Perform other duties as assigned.
LEVEL OF AUTHORITY & RESTRICTIONS
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This position requires working independently without overseeing others, with no authority in decision-making.
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This position requires working independently without overseeing others, with minimal authority in decision-making.
PHYSICAL & MENTAL DEMANDS
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Requires the ability to manage moderate levels of stress arising from schedules, workload, diverse or adversarial stakeholders, etc.
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Must be able to walk, talk, hear, use hands to handle, feel or operate objects, tools, or controls, and reach with hands and arms.
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Vision abilities required by this job include close vision and the ability to adjust focus.
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May be required to push, pull, lift, and/or carry up to 40 pounds.
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Must be willing and able to travel both locally and within the CTCLUSI service delivery area.
WORKING CONDITIONS & ENVIRONMENT
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Moderate noise level with frequent interruptions and distractions.
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Must be willing and able to travel both locally and within the CTCLUSI service delivery area.
Requirements:
MINIMUM JOB REQUIREMENTS
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Must be at least 18 years of age or older.
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High School Diploma or equivalent.
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Must have at least two (2) years of work experience as a medical or dental biller.
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Must obtain certification as a Certified Application Counselor as soon as training is available after hire and maintain annual re-certification.
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Must possess strong writing and communication skills.
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Experience and proficiency in the use of Microsoft products (Excel, Outlook, PowerPoint, Word, etc)
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Ability to communicate clearly and effectively in English, verbally, in writing or by other acceptable means.
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This position is considered a non-covered role per the CTCLUSI Background Investigations Policy. A state criminal background check and fingerprint-based background check will be required as a condition of employment.
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This position is subject to pre-employment and other authorized drug and alcohol testing in accordance with company policy.
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Must have employment eligibility in the U.S.
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Indian preference will be observed in the hiring process.
