What are the responsibilities and job description for the RCM Operations Specialist position at Dental Care Alliance?
Overview
We are seeking a detail-oriented and analytical RCM Operations Specialist with in-depth knowledge of the dental industry to join our dynamic team. In this role, you will be responsible for troubleshooting Fee Schedule and Plan discrepancies Your expertise will help streamline our Fee Schedule processes and improve our overall revenue cycle management. This is a remote position.
Responsibilities
Industry Knowledge: In-depth understanding of dental insurance industry practices, regulations, and trends.
Analytical Skills: Strong analytical and problem-solving abilities to interpret credentialing data, identify trends, and make informed decisions to optimize the fee schedule and plan process.
Intermediate Microsoft Office (Excel, PowerPoint, Visio) proficiency required. Dental Xchange knowledge. Denticon Experience preferred.
Expectations
Troubleshoot Payment Issues: Investigate and resolve payment discrepancies by analyzing billing errors, payment discrepancies, fee schedule adjustments, plan errors and insurance claim rejections in dental Xchange.
Communication and Collaboration with DCA Dental Offices, Revenue Cycle and other departments within DCA: Work closely with our dental practices to provide guidance on proper billing procedures, insurance plan set up and ensuring compliance with industry standards and best practices.
Insurance Carrier Liaison: Act as the point of contact between the dental offices and insurance carriers, facilitating communication and ensuring timely resolution of payment issues.
Analyze Billing Data: Monitor and assess billing data for trends in discrepancies and errors, providing insights and recommendations for process improvements.
Documentation and Reporting: Maintain accurate records of fee schedule, plans and carrier payment issues, resolutions, and communications with stakeholders; prepare reports for management on key findings and trends.
Training and Support: Conduct training sessions for dental office staff on billing protocols and effective claim submission practices and insurance verification process to minimize future issues.
Stay Updated: Keep abreast of changes in insurance policies, billing regulations, and industry standards to ensure compliance and optimize operations.
Qualifications
Bachelor’s degree in business, Healthcare Administration, or a related field experience preferred.
Minimum of 7 years of experience in dental billing, coding, or payor claims resolution in the dental industry.
Strong understanding of dental billing procedures, insurance claim processes, fee schedule and plan set up and relevant regulations.
Excellent analytical and problem-solving skills, with a keen attention to detail. Strong communication and interpersonal skills are essential for effective collaboration with internal teams and external partners.
Proficient in dental practice management software and Microsoft Office Suite is a must. Familiarity with payor reimbursement policies, payor website and how to navigate and communicate changes is essential.
