ROLE OVERVIEW
The Accounts Receivables Specialist is responsible for managing dental and medical outstanding insurance balances, following up on unpaid claims, and reducing accounts receivable (AR) aging.
KEY RESPONSIBILITIES
- Follow up on claims over 30+ days to ensure prompt resolution.
- Investigate denied, delayed, or underpaid claims and appeal when appropriate.
- Contact insurance payers to verify claim status and resolve payment delays.
- Partner with the Billing, Payment Posting, and Pre-Authorization teams to streamline claim resolutions.
- Identify trends in denials and non-payments and recommend process improvements.
- Serve as a peer collaborator for new hires, helping them navigate AR processes.
- Handle ad-hoc tasks and special projects assigned by management
ESSENTIAL QUALIFICATIONS
Prior experience in dental office revenue cycle functions, with expertise in:
- Scheduling & Registration - Understanding patient flow and eligibility verification.
- Insurance Verification - Confirming coverage, benefits, and policy limitations.
- Fee Schedules & Charging/Coding - Ensuring accurate claim submission using CDT, CPT, and ICD-10 codes.
- Claim Submission & Follow-Up - Knowledge of clean claim processing, payer-specific requirements, and handling rejections/denials.
- Insurance AR & Payment Posting - Reconciling EOBs, applying payments correctly, and identifying underpayments.
Strong knowledge of reimbursement & compliance processes for:
- Medicare, Medicaid, PPO, HMO, and Fee-for-Service (FFS) plans
- Payer guidelines, coordination of benefits (COB), and timely filing limits
- Insurance dispute resolution and appeal submission best practices
Proficiency in dental billing software & industry tools:
- Practice Management Systems (PMS): CareStack , WinOMS , OMSVision , Dentrix, Eaglesoft, etc.
- Insurance Portals & Clearinghouses: Working with Navinet , Availity, Change Healthcare, and payer-specific platforms
- Banking Reconciliation Software: Matching deposits to payments for financial accuracy
- Microsoft Office Suite: Strong Excel skills for data analysis and reporting
Technical & Analytical Skills
- Strong computer literacy with intermediate to advanced Excel proficiency (pivot tables, v-lookups, reporting).
- Excellent math and problem-solving skills related to claim calculations and insurance adjustments.
- Data entry expertise, including 10-key by touch, ensuring speed and accuracy in financial transactions.
Soft Skills & Work Ethic
- Strong interpersonal and organizational skills to work effectively within a team and independently.
- Excellent oral and written communication skills, particularly in handling payer escalations and patient billing inquiries.
- Demonstrates attention to detail, accuracy, and analytical thinking in identifying claim discrepancies.
- Accountable for quality work, meeting deadlines, and adhering to RCM compliance and SOPs.
What We Offer:
- Core Benefits & Wellness
- Comprehensive Medical, Dental & Vision Insurance (Virtual Care included)
- Confidential Employee Assistance Program (EAP) for you and your family
Financial Wellness
- Competitive Pay with Bonus Opportunities & Annual Merit Increases
- 401(k) Retirement Plan with Company Match
- Health Savings Account (HSA) options with HDHP plans
Life Insurance Protection
- Company-Paid Basic Life Insurance
- Optional Supplemental Life Coverage for You, Your Spouse & Children
Time Away & Life Balance
- Generous Paid Vacation (starting at 2 weeks.) + 6 Paid Holidays
- Short- and Long-Term Disability Coverage
- Supportive Leave of Absence Options
Compensation details: 24-28 Hourly Wage
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