Claims Coordinator

At CarolinasDentist in Spring Lake we care for our patients the way wed want our own families to be treated. From the moment our patients first walk through our door to admiring the beautiful smile in the mirror when they leave we make our patients feel comfortable unique and compassionately cared for. Our dedicated team in Spring Lake offers personalized treatment plans designed to meet our patients specific dental needs. Our highly trained and skilled dental clinicians at CarolinasDentist stay up to date on the latest advancements in dental care to ensure our patients enjoy excellent oral health and wear a beautiful smile for a lifetime.

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.

Reviews clinical note xrays and account ledger for cohesion of information
Creates and submits eclaims and paper claims attaching any necessary xrays notes
narratives charting etc. 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 nonpayments.
Maintains and completes all appeals and requests from insurance companies
Reviewing returned EOBs:
o Denials manages info needed for appealing claims
o Denials manages info needed for missing information or attachments
o 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 CD 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 required.

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 detailoriented 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.

ProblemSolving 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.