Position Summary
The Dental Auditor is responsible for reviewing patient charts, treatment documentation, insurance claims, billing, and financial records to ensure accuracy, compliance, and proper reimbursement. This position helps protect the practice from lost revenue, claim denials, documentation deficiencies, and billing errors.
Key Responsibilities
Chart & Clinical Documentation Auditing
- Review patient charts for complete and accurate clinical documentation.
- Verify treatment performed matches procedures posted and billed.
- Confirm required X-rays, periodontal charting, clinical notes, diagnoses, and supporting documentation are present.
- Verify provider signatures and required patient consent forms.
- Identify incomplete or missing clinical notes and follow up with the appropriate team member.
- Audit treatment plans to ensure completed treatment is properly documented and posted.
Insurance & Claims Auditing
- Review insurance claims before and after submission for accuracy.
- Verify correct CDT codes, tooth numbers, surfaces, quadrants, and supporting documentation.
- Ensure narratives, X-rays, periodontal charts, intraoral photos, and other attachments are included when required.
- Review denied, rejected, and underpaid claims and identify the reason for nonpayment.
- Confirm insurance payments are posted correctly according to the EOB/ERA.
- Identify claims that have not been submitted or followed up on within required timeframes.
- Monitor outstanding insurance aging and timely-filing deadlines.
- Identify opportunities for corrected claims or appeals when appropriate.
Financial & Production Auditing
- Compare scheduled/performed treatment against posted production.
- Identify completed procedures that were not posted or billed.
- Review adjustments, discounts, write-offs, refunds, and account credits for accuracy.
- Verify patient and insurance balances.
- Audit payment posting and allocation.
- Review accounts receivable for unusual or unresolved balances.
- Identify revenue leakage and report findings to management.
Compliance & Quality Control
- Help ensure billing and documentation practices comply with applicable regulations, payer requirements, and office policies.
- Identify patterns of coding, documentation, or billing errors.
- Maintain confidentiality of patient information and follow HIPAA requirements.
- Provide recommendations to improve front-office, clinical, insurance, and billing workflows.
Daily/Weekly Expectations
- Audit a designated number of patient charts and claims.
- Review previous-day production for posting discrepancies.
- Review outstanding and denied insurance claims.
- Track missing documentation and follow up until corrected.
- Maintain an Audit Correction Log documenting errors, responsible department, correction status, and completion date.
- Provide management with a weekly summary of findings, including recurring problems and financial impact.
Qualifications
- Minimum 2 years of dental insurance, billing, treatment coordination, or auditing experience preferred.
- Strong knowledge of dental terminology and CDT coding.
- Understanding of PPO, Medicare/Medicare Advantage, and other dental insurance plans.
- Experience with dental practice-management software; Dentrix experience strongly preferred.
- Knowledge of EOBs, ERAs, insurance aging, claim appeals, narratives, and supporting documentation.
- Strong attention to detail and ability to identify discrepancies.
- Excellent organizational and follow-up skills.
- Ability to communicate professionally with doctors, clinical staff, insurance coordinators, and management.
- Bilingual English/Spanish preferred.
Performance Standards
Success in this position will be measured by:
- Reduction in claim denials and rejected claims.
- Reduction in missing or incomplete documentation.
- Accurate procedure and payment posting.
- Timely identification and correction of billing errors.
- Improved collection of outstanding insurance balances.
- Identification and recovery of missed revenue.
- Completion of assigned audits and correction follow-ups.
- Clear reporting of recurring problems to management.
Accountability
The Dental Auditor is expected to identify problems—not simply document them. Each discrepancy should be tracked through correction and resolution whenever possible. Significant compliance concerns, repeated employee errors, unusual adjustments, or potential revenue loss should be immediately reported to management.
