Claims Coordinator

The Claims Coordinator ensures accuracy and timely filing for all dental claims for assigned office and reports problems and issues on follow up report to dental office. Reviews Accounts Receivable reports on assigned rotation for all offices, following up on outstanding insurance claims and balances; working problem EOBs, denials, and processing appeals as needed.

Core Responsibilities: 

• Reviews clinical note, x-rays, and account ledger for cohesion of information 

• Creates and submits e-claims and paper claims, this includes ortho claims. 

• Send claims through clearing house and manages all invalid and rejected claims. 

• Claims should be sent out within 48 hours of the date of service. 

• Any account or claim issues are included on a Follow Up report to the dental office or assigned to the designated clinical team member within PMS with the expectation that answers and corrections will be made within 48 hours of sending the report. 

• If accounts are unresolved from the dental office from the follow up report, an Urgent Weekly Report goes to the dental office. 

• Files corrected claims triaged from the AR Specialist based on returned problem EOBs 

• Manages Accounts Receivable report on an assigned schedule, reviewing accounts for outstanding insurance claims and balances. 

• Calling and following up with insurance companies on claims issues and non-payments. 

• Maintains and completes all appeals and requests from insurance companies 

• Reviewing returned EOBs: 

• Denials- manages info needed for appealing claims 

• Denials- manages info needed for missing information or attachments 

• Corrected claims and/or retractions 

• Tracking all outstanding insurance balances by category and reporting to OM when completed  

Administrative Responsibilities:
• Participates in special projects and tasks as assigned
• Fills in for other Claims Coordinators as needed
• Assists and conducts training of new CC RCT members
• Attends and contributes to monthly meetings
• Reports to CD-RCM with any grievances or issues

Experience: Previous experience in dental office administration, dental billing, or insurance claims processing is highly beneficial. Candidates with experience in medical claims processing may also be considered.

Knowledge of Dental Terminology: Familiarity with dental terminology and procedures is essential for accurately processing claims and communicating with dental providers and insurance companies.

Understanding of Insurance Processes: A good understanding of dental insurance policies, coverage limitations, and claim submission procedures is necessary. This includes knowledge of common insurance codes (e.g., CDT codes) and claim forms (e.g., ADA dental claim form).

Attention to Detail: Dental claims coordinators must be detail-oriented to accurately review claims, ensure all necessary information is included, and identify any discrepancies or errors.

Communication Skills: Strong communication skills are important for interacting with patients, dental providers, insurance companies, and other staff members. This includes both verbal and written communication skills.

Organizational Skills: The ability to effectively manage and prioritize multiple tasks, such as processing claims, following up on outstanding payments, and resolving claim disputes, is crucial in this role.

Computer Proficiency: Proficiency with dental practice management software and other computer applications used for claim processing and administrative tasks is typically required.

Customer Service Skills: Dental claims coordinators often interact with patients regarding billing and insurance matters, so good customer service skills are important for addressing inquiries and concerns in a professional and empathetic manner.

Problem-Solving Abilities: The ability to troubleshoot issues related to claim processing, billing errors, or insurance coverage discrepancies is valuable for resolving issues efficiently and effectively.

Ethical Standards: Knowledge of and adherence to legal and ethical guidelines related to patient privacy (HIPAA) and billing practices is essential.

In return for providing an excellent patient experience, we offer a great benefits package to include health and dental benefits, 401(k), holiday pay and paid time off.