Dental Biller

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 physic

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