Revenue Cycle Functions:

• Claim Submission: Incumbent to process paper and electronic claim forms to payors for chargeable and billable services. This includes resolving billing system edits (EDI/Charge Review) and determine the correction action to clear the error and produce clean claims for the Dental Center. Review key data within the claim form, such as provider, practice, CDT/CPT, fee and ensuring appropriate documentation is included for adjudication.
• Correspondence: Reviews billing correspondence for timely resolution. This will include applying appropriate denial and claim status codes. The incumbent is responsible to recognize insurance reimbursement issues, coding problems and other issues that could affect the financial condition of the clinic. The incumbents work closely with the Revenue Cycle Director to resolve identified trends and problems.
• Accounts Receivable by following up and reprocessing claims as necessary. This includes research complex billing issues of each account; confirms primary and secondary payers, closely evaluates coordination of benefits; identifies appropriate contract / plan to provide payment for all phases of care.
  • Analyzes complex financial data and identifies trends that contributes to aging accounts and common denials. Summarizes findings to share with management
  • Implement new systems and processes for managing the pursuit of unpaid or underpaid bills or claims, including drafting and submitting appeals letter to payors or escalation letters to patients.
• Patient Billing Inquiries: Collaborates with clinic managers/supervisors and providers (faculty, residents, students) to resolve billing inquires in-person, phone, email, standard mail, etc in a timely and professional manner. Educate patients of personal financial responsibility and expectation. This involves and in depth understanding of the basic dental insurance policies and the ability to communicate effectively to patients and payors. Nurture the patient relationship to encourage patient retention and contribute to the development of a patient-focus environment.

• The incumbent is responsible for collection and reconciliation of the cashier funds. This unit is responsible for reconciliation of the cashiering funds to the Axium Bank Report by Type, and for ensuring the Cash Handling Procedure is followed in the clinic. This includes the preparation and submission of daily journals for ATM, Lockbox and Credit Card deposits, ACH, eFT, i835 and insurance credit card payments using PeopleSoft. In addition to journal preparation, this position must maintain ancillary Excel spreadsheets for reconciliation, statistical and audit purposes.
• The incumbent prepares daily journals (Peoplesoft) to transfer the funds to our other SOD clinics and record the information in the excel database. The excel reports are generated by the incumbents for the MSO.
• The incumbent is responsible for the maintenance of the excel journal and deposit logs and the reconciliation of the monthly journals to ensure accuracy and completion against our weblinks reports. The SAS 112 reconciliation process is the responsibility of these employees. This position works closely with accounting and the controller's office

• Treatment Planning includes the creation of financial arrangements, pre-authorization determination of benefits and payment plan agreements. The interpretation of treatment plans, verification of insurance coverage and options available to the patients are the responsibility of the incumbents.

• Serves as a resource for front desk and treatment planners; resolves systems, procedural and policy issues during daily operations. Contribute to the development of new administrative processes to streamline billing workflow and improve efficiency.
• Keeps abreast of changes in government regulations and requirements of all third-party carriers. Drafts changes to systems, policies and procedures as needed.
• Provides back up as needed in all areas of the PBS, which requires cross training all functions including treatment planning support in the clinic.
• Assist in the development of training material on changes to systems or operational procedures.
• Assist management with specific tasks, training, and special projects.
• Work independently within departmental guidelines, exercise appropriate judgement and function effectively as a member of the Patient Billing Service team.
• Prioritize workload and meet productivity, accuracy and meet service level/aging targets.
• Attend department, unit and other meetings as required.
• Complete trainings and University requirements within deadlines.
• Perform other duties as assigned.