Dental Billing Specialist

Website: www.centralcityhealth.com

Who We Are: Central City Health (CCH) has been serving the underhoused and at-risk population in metro Detroit since 1972, by providing integrated healthcare services. Our services include primary and pediatric care, dental care, behavioral and SUD care, supportive housing, and community re-entry services, to name a few. In 2024, our President/CEO, Dr. Kimberly Farrow-Felton received the esteemed Healthcare Hero Award from Crain’s Detroit Business honoring her exceptional contributions to the health and well-being of our community.

Our Mission: To achieve wellness in the community by providing an array of primary and behavioral health care, housing, and substance abuse services with dignity and respect. Our Core

Values: CCH is guided by a set of values in fulfilling our mission.

Some Of Our Values Include

• An environment that supports health and recovery.
• Person centered principles in the delivery of care.
• An environment characterized by cultural sensitivity, integrity, teamwork and trust.
• A commitment to service excellence and continuous quality improvement.
• Persons served take both an active part in their treatment and the organization.
• An atmosphere of welcoming and accessibility to people seeking our services that assures “no wrong door.”
  
  

You Get

• 14 Paid Holidays Annually.
• 18 PTO Days (less than 1 Year; 27 Days on 1st Year Anniversary).
• Benefit Coverage after 30 Days: Medical/Dental/Vision/Short-term Disability.
• Company-Paid Life Insurance.
• Retirement Savings 403(b).
• Tuition Reimbursement.
• Continuing Education Allowance
  
  

General Description

The Dental Billing Specialist will perform advanced work to bridge the gap between dental providers, patients, and the insurance companies by making sure the correct information is updated and added to the electronic medical record before transmitting claims. This individual will ensure timely and accurate reimbursements by batching, reviewing, and correcting any internal claim errors before submission to the electronic billing clearinghouse. Upon claim submission to the proper clearinghouse, the biller will review the uploaded claims to correct any front-end edits that could prevent the claim reimbursements.

While overseeing the dental billing process, the Dental Billing Specialist is also responsible for posting (and recording) claim payments received, following up on non-paid claims to correct for reimbursement in a timely manner and processing any corrected and/or VOID claims. The Dental Billing Specialist should understand how to manage patient information in accordance with HIPAA regulations, know how to locate and understand provider manuals.

Responsibilities

• Prepares complex claims for dental services.
• Prepares claims adjustments, as necessary, (i.e., claims paid to wrong provider, refund requests, overpayments, etc.).
• Analyzes, researches, and resolves various claims-related issues (rejected claims, unbilled claims and/or improperly resolved claims) with limited supervision.
• Initiates investigation of questionable claims; may refer recommendations to Revenue Cycle Team. Refers complex or unusual issues to the Revenue Cycle Team for guidance.
• Informs Leadership of any claims related issues that affect the proper adjudication of claims.
• Ensures that the patients’ insurances are correctly entered into the system and that they are current at least three (3) days prior to patients’ arrival.
• Completes required reports as requested, (i.e., Billed Claims Report, Service Activity Log, (SAL) Reports, Medical Record Request Reports, Claims Payment Reports, etc.).
• Meets and exceeds production quantity and quality standards, as determined by Leadership.
• Completes dental provider credentialing process for existing and new insurances before treating respective patients as needed.
• Research patients' insurance copay amounts, provide information to front desk staff to ensure that the patient makes payment before treatment is performed.
• Pre-authorize and confirm all necessary dental procedures are covered prior to the start of patient treatment.
• Ensures payment of dental claims – bill accurate claims with required attachments, works denied claims and discover billing issues in order to receive optimal payment of claims.
• Trains staff in the dental billing processes and procedures as needed.
• Must maintain confidentiality relating to treatment in accordance with HIPAA guidelines
• Interacts verbally and in writing with team members throughout the company, as needed.
• Performs other duties as assigned.
  
  

Education And Experience

• High school diploma or equivalent required
• A minimum of four (4) years of advanced dental claims processing experience is required.
• Knowledge of dental health, professional and facility claims processing, payment, and denial resolution as well as diverse insurance background preferred.
• Dental billing or coding certification preferred.
• Demonstrated knowledge of the patient scheduling and registration process.
• Demonstrated knowledge of ICD, HCPC and CPT coding methodologies.
• Demonstrated knowledge of CMS, Third Party Payers, and Managed Care Guidelines
• Knowledge of dental x-rays, dental terminology, and the dental authorization process as well as a diverse insurance background required.
• Experience with reviewing authorization requests for pediatric and adult dental x-rays required.
• Problem solving and research skills; analytical, communications and critical thinking skills.
• Working knowledge of FQHC and Community Dental Health claims.
  
  

About Central City Health

Central City Health will be recognized in the community as a premier provider of accessible comprehensive behavioral and physical health care, substance abuse services, and housing opportunities that lead consumers toward self-sustainability. Our mission is to achieve wellness in the community by providing an array of primary and behavioral health care, housing and substance abuse services with dignity and respect.Vision