MUST SUBMIT RESUME WHEN RESPNONDING TO THIS EMAIL FOR CONSIDERATION
NEEDS TO HAVE AT LEAST 4 YEARS OF DENTAL BILLING EXPERIENCE
MUST RESIDE IN CENTRAL OR EASTERN TIMEZONE
(PLEASE DO NOT APPLY IF YOU DO NOT MEET THE REQUIEMENTS LISTED ABOVE)
THIS JOB IS FULLY REMOTE
Experience: 4+ Years of Dental Billing Experience / Needs Experience with Meditrak, Dentix, QSI, or similar systems
Contract to possible hire or extension
Other scheduling requirements: Breaks and lunches are scheduled and cannot be customized. 30-minute lunch, (2) 15-minute breaks before and after lunch period
This position is responsible for auditing of claims processing, specialty care referrals, group set up, performance guarantee groups, compliance reporting for specified groups, schedule of benefits and provider fee schedules at individual, group, and company-wide levels.
Job Summary Details:
Audit and analyze claims data to ensure processing accuracy and service levels are met at individual, group, and company-wide levels
Understand claims processing policies and procedures and other processes in order to perform audits
Review and validate group set up including benefit schedules and frequencies to ensure claims are processed accurately according to group’s contract
Audit provider compensation schedules linked in the system to ensure that procedure codes and dollar amounts match up according to signed contracts
Analyze, document, and review audit results to identify trends and report to appropriate departments for training purposes
Follow up with appropriate departments to ensure necessary corrections are made timely
Maintain a safe and productive working environment following established protocols
Promote and support a teamwork culture and environment internally and externally
Perform an average of 1,250 audits monthly to ensure compliant with contractual and policy requirements.
Other duties as assigned or determined appropriate
Distinguishing Characteristics:
Distinguishing Characteristics for Sr. Internal Auditor:
Experience in claims processing, claims audit and/or analyzing and reviewing claims data required, within the Dental PPO or DHMO environment highly preferred.
Assist with the development of department policies and procedures.
Participate in system enhancement discussions with management and IT Department
Strong understanding of claims processing, preferably within dental the Dental PPO or DHMO environment
Experience in audit or reviewing and analyzing data preferred
Proficiency with Microsoft Word and Excel
Strong analytical skills for reporting and trend analysis
Ability to work independently and meet objectives
Ability to be discreet and keep audit results confidential
Detail-oriented
Good math skills to calculate claims and audit results
Ability to analyze complex claims information
Strong organizational and prioritization skills
Strong written and oral communication skills
Ability to define problems, collect relevant data, establish facts, and draw valid conclusions
Ability to utilize resources available to research issues and follow through until resolved
Education Level: Minimum of High School or GED High school diploma or equivalent required
Specific Skills/Knowledge
Excellent listening skills to appropriately handle calls
Excellent verbal and written communication skills in the English language
Outstanding customer service skills
Knowledge of dental terminology and practices
Working knowledge of Microsoft Office (Excel, Outlook, and Word)
Minimum typing speed of 40 wpm