Job Summary
We are seeking a detail-oriented and highly organized Billing Specialist to manage and oversee our billing processes. The ideal candidate will possess a strong background in accounting and finance, with expertise in various financial software and accounting systems. As a Billing Specialist, you will be responsible for accurate invoicing, accounts receivable management, and ensuring compliance with financial regulations. Your role is essential in maintaining the integrity of our financial operations and supporting the overall fiscal health of the organization.
The Dental Billing & Accounts Receivable Specialist is responsible for managing the day-to-day billing and revenue cycle functions of Cumberland Dental Specialists across both the pediatric and orthodontic departments. This position plays a critical role in maintaining accurate patient accounts, maximizing insurance collections, managing practice accounts receivable, processing payments, submitting claims, and providing exceptional customer service to patients regarding their financial accounts.
The ideal candidate will be highly organized, detail-oriented, financially accountable, and comfortable working independently while maintaining a high level of accuracy. This individual must have strong knowledge of dental insurance, Explanation of Benefits (EOBs), dental ledgers, claims processing, payment posting, and accounts receivable management.
Because the practice utilizes Dentrix for pediatric dentistry and Orthofi for orthodontics, the candidate must be comfortable navigating both systems and maintaining accurate financial records across each platform.
Essential ResponsibilitiesAccounts Receivable Management
- Maintain and monitor the practice's accounts receivable on a daily, weekly, and monthly basis.
- Generate, review, and maintain AR reports for both pediatric and orthodontic departments.
- Identify outstanding patient and insurance balances and develop appropriate follow-up strategies.
- Monitor aging accounts and prioritize collection efforts based on account age and balance.
- Research outstanding balances and identify discrepancies, posting errors, insurance issues, or unresolved claims.
- Communicate AR trends, concerns, and opportunities to management.
- Assist in establishing and maintaining appropriate AR goals for the practice.
- Maintain accurate documentation of collection activity and account follow-up.
- Identify accounts requiring additional review or escalation to management.
Insurance Claims & Follow-Up
- Prepare, review, batch, and submit dental insurance claims accurately and in a timely manner.
- Ensure claims are submitted to the correct insurance carrier with all required documentation.
- Review claims for accuracy prior to submission, including patient information, provider information, procedures, fees, attachments, and insurance information.
- Track outstanding insurance claims and follow up on unpaid or delayed claims.
- Research rejected, denied, or partially paid claims and determine appropriate next steps.
- Correct and resubmit claims when necessary.
- Communicate with insurance companies regarding claim status, benefits, payment, denials, and discrepancies.
- Maintain knowledge of participating and non-participating insurance plans applicable to the practice.
- Understand insurance benefit limitations, deductibles, annual maximums, waiting periods, frequency limitations, and other relevant plan provisions.
Payment Posting
- Receive and accurately post all payments received by mail, electronic payment, ACH, credit card, check, and other approved payment methods.
- Post insurance payments and patient payments accurately to the appropriate patient ledger.
- Reconcile electronic insurance payments and Explanation of Benefits with payments received.
- Ensure payments are posted to the correct patient, provider, procedure, and account.
- Identify and resolve posting discrepancies.
- Process patient co-pays and outstanding balances accurately.
- Maintain accurate daily payment batches and reconcile payments against deposits and electronic remittances.
- Assist with daily and monthly reconciliation processes.
- Identify duplicate payments, unapplied payments, credits, and account discrepancies and resolve appropriately.
Dentrix & Orthofi Responsibilities
- Demonstrate advanced working knowledge of Dentrix ledgers, including account history, payment posting, adjustments, credits, balances, insurance transactions, and claim information.
- Navigate Orthofi effectively for orthodontic patient accounts, payments, insurance information, and financial records.
- Maintain consistency and accuracy between financial documentation and practice management software.
- Troubleshoot discrepancies within patient ledgers and identify the source of account balances.
- Ensure all financial transactions are documented appropriately and accurately.
Patient Billing & Customer Service
- Generate and send patient statements and bills on a regular schedule.
- Respond to patient calls and inquiries regarding billing, balances, insurance payments, and account questions.
- Explain patient account balances clearly and professionally.
- Review and explain Explanation of Benefits (EOBs) to patients, including:
- Insurance payments
- Insurance adjustments
- Patient responsibility
- Deductibles
- Co-insurance
- Non-covered services
- Denials
- Remaining balances
- Help patients understand the difference between the insurance company's responsibility and their personal financial responsibility.
- Process patient payments and establish payment arrangements in accordance with practice policies.
- Handle billing concerns and complaints professionally and escalate issues when appropriate.
- Maintain patient confidentiality and comply with HIPAA and all applicable privacy regulations.
Financial Reporting & Reconciliation
- Prepare routine billing and AR reports for management.
- Monitor daily collections and payment activity.
- Reconcile payment batches and deposits.
- Review outstanding credits and unapplied payments.
- Identify trends in outstanding insurance and patient balances.
- Assist management with monthly financial reporting.
- Maintain accurate records of collections, adjustments, refunds, and outstanding balances.
- Assist with identifying opportunities to improve the practice's collection rate and reduce AR.
Administrative Responsibilities
- Maintain organized electronic and paper billing records as applicable.
- Process correspondence received from insurance companies and patients.
- Maintain current insurance carrier information within the practice management systems.
- Assist with insurance credentialing or payer-related administrative tasks when requested.
- Assist with refunds and account corrections according to established practice policies.
- Work collaboratively with the front desk, clinical team, treatment coordinators, doctors, and management to resolve financial and insurance issues.
- Participate in staff meetings and contribute ideas for improving billing and collection processes.
- Maintain current knowledge of dental billing procedures, insurance regulations, and payer requirements.
- Perform other duties related to the financial and administrative operations of the practice as assigned.
Required Qualifications
- Previous experience in dental billing and accounts receivable required.
- Strong working knowledge of dental insurance and dental terminology.
- Demonstrated proficiency with dental practice management software.
- Strong knowledge of Dentrix, particularly patient ledgers and financial transactions.
- Ability to learn and effectively utilize Orthofi.
- Experience processing and posting insurance and patient payments.
- Experience submitting and following up on dental insurance claims.
- Ability to accurately read and explain dental Explanation of Benefits (EOBs).
- Strong mathematical and reconciliation skills.
- Excellent written and verbal communication skills.
- Strong attention to detail and accuracy.
- Ability to handle confidential patient and financial information appropriately.
- Ability to prioritize multiple responsibilities and meet deadlines.
- Professional and compassionate approach when communicating with patients regarding financial matters.
Preferred Qualifications
- 2+ years of dental billing experience.
- Experience working in a pediatric dental and/or orthodontic practice.
- Advanced Dentrix knowledge.
- Experience with Orthofi or another orthodontic practice management system.
- Experience managing a multi-provider practice's AR.
- Experience working with multiple insurance carriers.
- Knowledge of dental insurance coordination of benefits.
- Experience with electronic claims, electronic remittance advice (ERA), and electronic payment posting.
- Experience with dental billing audits and account reconciliation.
Key Performance Expectations
Success in this position will be measured by the individual's ability to:
- Maintain accurate patient and insurance ledgers.
- Submit clean and timely insurance claims.
- Minimize outstanding insurance claims and patient AR.
- Maintain accurate and timely payment posting.
- Reconcile payments and deposits accurately.
- Reduce the number of aged accounts receivable.
- Maintain consistent and timely patient billing.
- Resolve billing issues efficiently and professionally.
- Accurately explain EOBs and patient financial responsibility.
- Maintain confidentiality and compliance with HIPAA.
- Demonstrate strong proficiency in Dentrix and Orthofi.
- Communicate effectively with patients, insurance companies, and internal team members.
- Identify billing and collection issues before they negatively impact the practice's revenue cycle.
Core Competencies
Accuracy & Attention to Detail
Maintains a high level of accuracy when posting payments, submitting claims, reconciling accounts, and maintaining patient ledgers.
Financial Accountability
Understands the importance of timely collections, accurate AR reporting, and protecting the financial health of the practice.
Insurance Expertise
Understands dental insurance processes and can confidently interpret EOBs and explain patient responsibility.
Organization
Effectively manages large volumes of claims, payments, patient accounts, statements, and follow-up tasks.
Communication
Communicates financial information clearly and professionally with patients, insurance companies, and team members.
Problem Solving
Investigates discrepancies and develops solutions rather than simply identifying problems.
Confidentiality & Professionalism
Maintains strict confidentiality regarding patient, insurance, and financial information.
Teamwork
Works collaboratively with the entire practice to ensure accurate financial information and a positive patient experience.
Physical & Work Environment
This position is primarily office-based and requires extended periods of computer and telephone use. The employee must be able to work effectively in a fast-paced dental practice environment and manage multiple priorities while maintaining accuracy and professionalism.
Pay: $23.00 - $26.00 per hour
Benefits:
- 401(k)
- Employee discount
- Health insurance
- Paid sick time
- Paid time off
Work Location: In person
