Smile Brands Inc. · 4 hours ago

Orthodontic Insurance Claims Specialist

Home, KS

Full-time

Remote

Entry, Mid Level

$15/hr - $20/hr

2+ years exp

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Responsibilities

Calling Insurance Carriers, or any other practical research resources (i.e. computer search tools), verify claim has been received and what is the outcome paid and or denial reason.

Update all patient accounts to correct inaccurate information i.e. demographic, eligibility dates, termination date and contract allowable and or maximum.

Responsible for managing workflow of the assigned accounts and prioritizing the issues to meet all deadlines for filing to obtain maximum reimbursement.

Understand and stay informed of changes with the procedures and laws for specific insurance carriers or payers.

Establish and maintain an accurate understanding and application of departmental policies and procedures in regards to daily assignments.

Understand, support, enforce and comply with company policies, procedures and Standards of business Ethics and Conduct.

Audit insurance claims to identify and provide required attachments and audit attachments for completeness and suitability.

Work zero paid Orthodontic Explanation of Benefits (EOB) and take action to appeal or properly adjudicate claims.

Work partial paid Orthodontic Explanation of Benefits (EOB) and take action to appeal or properly adjudicate claims.

Ensure claim submission for secondary coverage within timely filing limits

Conduct full patient account audits to determine appropriate action.

Provide training and guidance to offices on proper Orthodontic contract and Orthodontic patient insurance record setup.

Build relationships and maintain open communication with dental office staff, internal departments and company representatives.

Communication with the upper leadership is imperative.

Qualification

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Collections experienceDental/medical insurance knowledgeCustomer service skillsOrthodontics billing experience