Description
GoTo Telemed seeks a detail-oriented and compliance-minded Dental Biller to manage comprehensive Revenue Cycle Management (RCM) operations for our internal dental clinics. In this critical role, you will serve as the backbone of our financial operations, managing the complete end-to-end billing lifecycle from patient eligibility verification through accounts receivable collections. This position requires expertise in dental coding, insurance verification, claims management, and regulatory compliance (OIG, HIPAA, and state-specific requirements). Your work directly impacts patient satisfaction, clinic cash flow, and regulatory standing.
Primary Responsibilities
Insurance Eligibility & Verification
- Verify patient dental insurance eligibility and benefits prior to appointment scheduling and service delivery
- Confirm coverage details including deductibles, maximums, copays, and frequency limitations using secure insurance verification portals
- Identify pre-authorization and referral requirements and obtain necessary approvals before procedures
- Maintain accurate, up-to-date insurance information in practice management systems
- Flag coverage gaps, exclusions, and limitations that may affect billing and collections
Appointment Booking & Patient Registration
- Coordinate with scheduling team to ensure complete and accurate patient demographic and insurance data capture during appointment booking
- Validate patient information for accuracy (name, date of birth, insurance policy numbers, etc.)
- Update patient records when insurance information changes or policies are renewed
- Communicate pre-authorization requirements and financial responsibilities to patients before service delivery
- Document patient consent for services and billing in compliance with HIPAA and state telehealth laws
Dental Coding & Claims Preparation
- Accurately code dental procedures using Current Dental Terminology (CDT) codes and appropriate procedure modifiers
- Review clinical documentation and treatment codes provided by clinical staff
- Assign correct ICD-10 diagnostic codes when applicable (e.g., medical insurance claims for surgical services)
- Apply appropriate telehealth modifiers (GT, 95, FQ, FR) for telehealth-delivered services in accordance with payer policies
- Verify correct place of service (POS) coding for teledentistry encounters (POS 02 or 10 as applicable)
- Ensure complete charge capture and coding accuracy to minimize claim denials
Claims Submission & Management
- Submit dental claims electronically and via print-to-mail within prescribed timeframes (typically within 5-30 days of service)
- Prepare and mail physical claim documentation when required by payers or for services not accepted electronically
- Track all submitted claims with documentation of submission date, claim number, and claim status
- Monitor claims for timely payment (benchmark: 30-40 days from submission)
- Flag claims at risk of denial or delay for proactive follow-up
- Comply with all payer-specific submission requirements including formatting, documentation, and procedural requirements
Accounts Receivable (AR) Follow-Up & Collections
- Conduct systematic follow-up on all outstanding claims past 15 and 30 days using phone, email, and secure patient messaging
- Contact insurance companies to obtain claim status, identify reasons for delays, and resolve pending issues
- Send timely patient statements for patient responsibility balances (weekly for balances exceeding 30 days)
- Follow up on patient balances through phone calls, statements, and payment plan negotiations
- Implement systematic collection procedures for delinquent accounts (30+ days past due)
- Negotiate payment plans and settlements with patients when appropriate while maintaining professional, non-judgmental communication
- Document all collection activities, patient communications, and payment arrangements in patient records
Claims Denial Management & Appeals
- Analyze claim denials and rejections to identify root causes (coding errors, missing documentation, eligibility issues, etc.)
- Submit corrected claims with necessary documentation changes
- Prepare and submit formal appeals for denied claims with supporting clinical documentation and policy justification
- Track appeal status and resubmit as needed until resolution
- Maintain denial tracking reports to identify patterns and implement process improvements
- Calculate and recover underpayments and contractual adjustments
Payment Posting & Reconciliation
- Post insurance payments and Explanations of Benefits (EOBs) accurately to patient accounts
- Reconcile EOBs with submitted claims and identify discrepancies
- Post patient payments and apply to correct accounts
- Track write-offs and contractual adjustments per payer agreements and fee schedules
- Maintain clear audit trails for all transactions
- Reconcile monthly payment totals with banking records
Print-to-Mail Operations
- Identify claims and statements requiring physical mail delivery
- Prepare documentation for printing and mailing (claims, patient statements, appeals)
- Maintain print-to-mail logs with tracking information
- Verify mailing addresses and ensure HIPAA-compliant delivery
- Track delivery of critical documents using postal tracking when available
Requirements
Compliance & Documentation
- Maintain strict adherence to HIPAA Privacy, Security, and Breach Notification Rules
- Ensure all patient communications comply with Telehealth Patient Rights and state-specific requirements
- Follow OIG compliance program guidelines including exclusion list checks (HHS OIG LEIE database)
- Document all billing activities, communications, and decisions in patient records
- Maintain confidentiality of patient Protected Health Information (PHI) at all times
- Comply with state-specific teledentistry and telehealth billing regulations
- Report potential compliance concerns through established compliance channels
Reporting & Analytics
- Generate daily, weekly, and monthly revenue cycle reports including:
- Days in Accounts Receivable (DAR) by payer
- Claim submission rates and approval rates
- Denial rates and denial reasons
- Collection rates and aging AR analysis
- Payment posting timeliness
- Identify trends and opportunities for process improvement
- Communicate financial metrics to management and clinical teams
- Track Key Performance Indicators (KPIs) including collection rates, claim approval rates, and AR aging
Required Qualifications & Skills
Education & Certification
- High school diploma or GED required
- Formal training in dental billing, medical billing, healthcare administration, or related field strongly preferred
- Current certification in one of the following preferred:
- Certified Professional Biller (CPB) through AAPC
- Certified Dental Coder (CDC) through AADC
- Certified Medical Reimbursement Specialist (CMRS)
- Registered Health Information Technician (RHIT)
- Current knowledge of CDT codes and ICD-10 coding standards
Technical Skills
- Advanced proficiency with Microsoft Office Suite (Excel, Word, Outlook)
- Proficiency with practice management software and Electronic Health Record (EHR) systems
- Ability to navigate insurance company portals and claim submission systems
- Experience with dental coding software and/or encoder systems
- Strong data entry and computer literacy skills
- Familiarity with HIPAA-compliant communication platforms and secure messaging
Compliance & Regulatory Knowledge
- Comprehensive understanding of HIPAA Privacy Rule, Security Rule, and Breach Notification Rule
- Working knowledge of OIG Anti-Kickback Statute, Stark Law, and exclusion list compliance
- Understanding of state-specific telehealth/teledentistry regulations and billing requirements
- Knowledge of CMS telehealth policies and modifier requirements (modifiers 95, GT, FQ, FR)
- Familiarity with CDT and CPT coding standards for dental procedures
- Understanding of medical billing basics for surgical/medical procedures billed with medical insurance
Soft Skills & Competencies
- Attention to Detail: Exceptional accuracy in data entry, coding, and claims management with ability to spot and correct errors
- Communication: Strong written and verbal communication skills for professional interaction with patients, insurance companies, and internal teams
- Problem-Solving: Ability to investigate claim denials, identify root causes, and implement solutions
- Time Management: Ability to prioritize multiple tasks and meet established deadlines
- Customer Service: Patient, professional demeanor when handling sensitive billing questions and collection calls
- Organization: Ability to maintain accurate records and manage complex workflows
- Analytical Thinking: Ability to interpret EOBs, identify trends, and recommend process improvements
- Professionalism: Ethical conduct and unwavering commitment to compliance and patient confidentiality
- Adaptability: Ability to learn new systems and adjust to evolving payer policies and regulations
Compliance & Background Requirements
- OIG Exclusion List Check: Candidate will be checked against HHS OIG LEIE database before hire and periodically during employment
- Background Check: Standard criminal background check required per healthcare industry standards
- HIPAA Compliance Training: Mandatory HIPAA certification and compliance training required before hire and annually thereafter
- Exclusion List Monitoring: Candidate must comply with periodic re-verification against HHS OIG Exclusion List and state-specific exclusion databases
- Professional Conduct: Commitment to ethical billing practices, compliance with fraud and abuse laws, and adherence to state dental practice regulations
- License Verification: If applicable to the state, candidate must maintain any required healthcare administrative licenses
