Dental Svcs Billing & Collection Specialist - Alameda Health System

SUMMARY: The Dental Billing and Collection Specialist is responsible for all aspects reviewing charges and payer contracts for claims and performing third party billing and collection activity for hospital and clinic services.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1. The Dental Billing and Collection Specialist is responsible for all aspects of billing and collecting primary, secondary, and tertiary payers for AHS claims including:

2. Identifying issues or trending and provide suggestions for findings and claims activity performed. Review the account information and necessary system applications to determine the next appropriate work activity. Verify claims have passed edits utilizing appropriate resources and applications. Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers. Edit claims to meet and satisfy billing compliance guidelines for electronic submission. Manage and maintain work list inventory, complete reports, and resolve high priority and aged inventory.

3.Respond timely to emails and telephone messages as appropriate. Communicate issues to management, including payer, system or escalated account issues.

4. Maintains information or operational records; screens reports for completeness and mathematical accuracy; list, abstracts, or summarizes data; compiles routine report from a variety of sources.

5. May, as a secondary responsibility, review notes, receipts, permits, licenses, etc; computes and receives fees when the amount is not in question or is readily obtainable from fixed schedules; posts data; keeps records, and prepares reports in accordance with pre-determined forms andprocedures.

6. Prepares billing documents for collection of revenues from third party payer programs and patients; checks and verifies charge rates for services; reconciles patient account balances verifies payments.

7.Reviews billing documents to assure program compliance for Medicare, Medi-Cal and insurance programs; assures that all appropriate medical documentation is included in the billing package.

8. Responsible for all aspects of follow up and collections on insurance balances, including making telephone calls, accessing payer websites. Identify issues or trending and provide suggestions for resolution. Accurately and thoroughly documents the pertinent collection activity performed. Review the account information and necessary system applications to determine the next appropriate work activity. Verify claims adjudication utilizing appropriate resources and applications. Initiate telephone or letter contact to patients to obtain additional information as needed. Perform appropriate follow-up functions, including manual re-submissions as well as electronic attachments to payers. Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.

9. Reviews billing documents to assure program compliance for Medicare, Medi-Cal, and insurance programs; assures that all appropriate medical documentation is submitted timely.

10. Other duties as assigned.

MINIMUM QUALIFICATIONS:
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

Required Education: High school diploma or equivalent education.

Minimum Experience: One year of experience in a Revenue Cycle area within the Alameda Health System; OR the equivalent of two years’ experience, performing medical billing or medical accounts receivable functions in a healthcare insurance related environment.