Who are we?
Pure Dental Brands is a Dental Service Organization (DSO) supporting 65+ family and specialty offices in nine states throughout the US. Our team members make a difference each day. Whether they are in one of our practices treating our patients or at the Service Center supporting our team members, their contributions matter. The Revenue Cycle Management department implements and promotes consistent revenue integrity practices in compliance with state and federal guidelines.
Who are we looking for?
We are seeking a new Revenue Cycle Analyst team member who is motivated, driven, extremely detailed oriented, organized, and serves as a Subject Matter Expert to optimize reimbursement by ensuring correct processes are being followed in order to achieve KPI and Best Practice benchmarks. This position is based out of St. Petersburg, FL supporting various locations/practices in multiple states.
What do they do?
The Revenue Cycle Analyst will be responsible for the completeness of all claim-related issues in accordance with established company protocols. As such, the Revenue Cycle Analyst must have a strong working knowledge of the entire Revenue Cycle process which includes Appointment Scheduling, Insurance Verification, Charge Capture, Claim Submission, Adjudication, Payment Posting, Denial Management, Claim Appeals, Adjustments/Write-Offs, Credit Balances/Refunds, Patient Responsibility, Collections, and Reporting.
• Audit claim submissions of prior day to ensure all claims were submitted to Clearinghouse.
• Daily review of claim rejection and validation errors; correct claim errors or contact the practice, to ensure claims are submitted to the Clearinghouse in a timely manner. Track validation errors and provide monthly report to RC Manager in order to make necessary changes to increase “clean claims rate”.
• Follow-up on all open claims until full payment has been received by the Payer and Patient based on contractual fee schedules, or final claim resolution.
• Initiate the accurate and timely processing of all secondary claims, as needed.
• Work denied claims and resubmit claims for reimbursement to the insurance companies for appropriate reimbursement; contest charges that are not paid or underpaid with the insurance carrier. Access available third party and governmental on-line services and/or websites to obtain current carrier guidelines, verify eligibility, and re-file claims, if necessary. If claim is denied, ensure correct denial code is used.
• Begin claim appeals according to payer specifics, timely-filing guidelines; reviews clinical documentation for appeals and composes detailed formal appeal letters for payment or contacts provider for appeals letter.
• Retrieve and submit appropriate dental record documentation based on third party requests.
• Audit patient accounts prior to issuing refunds. Ensure balances and ledgers are accurate prior to issuing patient or insurance refunds.
• Adjustments/Write-Offs: ensure policies are being followed according to company guidelines; audit accounts prior to making any adjustments or write-off; ensure correct adjustment or write-off codes are used.
• Submit patient statements based on company guidelines; follow-up on patient accounts; create patient payment plans, if needed.
• Submit delinquent patient accounts to collection agency; if payments are made by patients, ensure correct process is followed based on company guidelines.
• Monthly Reports: provide monthly AR analysis and trend reporting to RC Manager.
• Supportive duties to Billing Specialist/Payment Poster and other duties as assigned
• 5+ years Revenue Cycle Management experience, preferably in a Dental environment
• Dentrix experience preferred
• Payment Posting experience preferred
• HS Diploma
• Knowledge of Medicaid/PPO/HMO dental insurance plans and networks a plus
• Ability to work independently and follow through on tasks
• Strong team player, analytical, critical thinking and problem-solving skills