UNIV - Dental Billing Specialist - College of Dental Medicine

Job Description Summary

The Billing Specialist will primarily focus on payor reimbursement, Accounts Receivable, denial management, recognize potential high-risk accounts, and develop techniques to improve collections and streamline processes. Will pursue resolution for all patient issues regarding patient accounts. Review/analyze patient accounts and take the necessary steps to resolve patient/guarantor issues. Assist with escalated/high priority account issues. Provide customer service as needed. The College of Dental Medicine (CDM) MUSC billing team member will manage collection issues with CDM Leadership, resolve issues, apply new information to future collection issues, and make suggestions to enhance our efficiency and effectiveness through process improvement. Act as a point of contact and resource for CDM Faculty, Residents and Staff for coding and accounting questions, assistance with accounts, and policy questions. Provide teaching and guidance for CDM students regarding patient coding, patient estimate and account management and financial treatment plans. Establish and maintain positive working relationships with patients, payers, team members, and clients. Maintain confidentiality of patient information, organization data and information always in compliance with HIPAA regulations.

Entity

Medical University of South Carolina (MUSC - Univ)

Worker Type

Employee

Worker Sub-Type​

Classified

Cost Center

CC000058 CDM Dean Finance & Administration

Pay Rate Type

Hourly

Pay Grade

University-GEN08

Pay Range

45,300.00 - 61,100.00 - 77,000.000

Scheduled Weekly Hours

40

Work Shift

Job Description

30% - Billing/Coding:

• Accurately bill BCBS of SC, Medicaid, self-pay/uninsured, accepted federal grant programs, and commercial dental insurance, processing claims in accordance with payer requirements and organization policy

• Regularly audit claims and EHR documentation for accuracy and Federal, State, and facility policy compliance

• Aid member clients filing claims for non-accepted plans in compliance with CDM MUSC policies.

• Post and allocate payments, electronic remits, and paper explanation of benefits (EOBs).

• Submit pre-treatment estimates according to CDM MUSC policy and upon member client request •Provide treatment plan and estimated cost review upon request

• Process fee adjustment request according to CDM MUSC policies

• Escalate requests that do not meet policy adherence to Clinical Affairs for determination

• Correct claim and charge errors; audit for verification which includes but is not limited to audit of coding, payments, and EHR to identify and rectify any missing or incorrect charges.

• Correct transaction entry errors within EHR -(Essential)

 

30% - Accounts Receivables:

• Provide Efficient and effective account receivable services on behalf of our member clients to maximize reimbursement and support CDM revenue cycle performance

• Assist with the collections of receivables for guarantor and any third-party payers by monitoring accounts receivables, checking claim status and resubmitting claims of overdue accounts, filing corrected claims or appeals and alerting supervisor of seriously overdue accounts and trends.

• Identify and address significantly overdue accounts according to state and facility policies

• Issue correspondence related to balances, including patient account statements

• Thoroughly research and resolve credit balances.

• Process refunds according to CDM MUSC and SC State policies

•Perform deposit reconciliation for all of CDM MUSC deposits according to separation of duties.

• Answer phone calls from patient and responsible parties regarding account balances and/or other account related matters.

• Maintain complete and accurate billing and accounts receivable records

30% - Account Maintenance:

• Timely and accurate communication with CDM Faculty, Residents, Staff and Students in accordance with department processes

• Provide regular and Ad Hoc reporting to CDM Leadership for missing charges and unapproved charges / documentation; weekly, monthly, & yearly. Audit when needed to identify trends.

• Identify issues, make updates to Insurance background maintenance within EHR, and assist with additional background maintenance tasks as assigned.

• Assists supervisor and administration with escalated patient account issues; works quickly, accurately, and professionally to resolve high priority patient accounts -(Essential)

10% - Additional Responsibilities:

• Act as a point of contact and resource for CDM Faculty, Staff and Students for coding and accounting questions