UNIV - Dental Billing Specialist - College of Dental Medicine

Responsibilities

• Review charges within Charge Review and Modifier Review work queues to identify coding, modifier, documentation, or billing issues that may affect accurate claim submission and reimbursement.
• Research and correct claim, charge, coding, and modifier errors through review of clinical documentation, EHR records, payer responses, and account activity.
• Perform account and chart audits to verify coding accuracy, account balances, claim integrity, and supporting documentation before billing follow-up or correspondence is completed.
• Post and reconcile insurance and patient payments, electronic remittances, and paper explanation of benefits (EOBs).
• Establish, monitor, and maintain payment plans for eligible patients in accordance with MUSC and CDM policies.
• Process claim corrections, reconsiderations, appeals, and resubmissions and provide supporting documentation when appropriate to resolve denials and support reimbursement.
• Respond to patients and responsible parties regarding account balances, billing questions, insurance claims, payments, and payment arrangements.
• Respond to patient MyChart messages and Secure Chat requests from CDM faculty, staff, and students regarding billing and patient account concerns.
• Monitor accounts receivable and perform timely follow-up on unpaid, denied, underpaid, rejected, and aging claims.
• Research claims incorrectly processed as out-of-network and work with participating insurance carriers to request correction or reprocessing when appropriate.
• Research missing insurance payments and remittances and initiate follow-up to ensure payments are properly identified, posted, and reconciled.
• Identify third-party payer payments, research deposited funds, and coordinate the transfer or correction of misapplied or misplaced payments to the appropriate patient account.
• Review and process paper and electronic correspondence requiring billing, payment, or claims follow-up and document actions taken within the patient account.
• Research and resolve credit balances, unapplied payments, and overpayments.
• Process appropriate refunds in accordance with MUSC and applicable State policies.
• Maintain complete and accurate billing, payment, claim, and accounts receivable records.
• Identify recurring account, denial, reimbursement, or collection trends and escalate significant concerns to leadership.
• Correct patient demographic, guarantor, coverage, and insurance information within the EHR when necessary to support accurate billing and claim adjudication.
• Perform insurance verification and identify eligibility, coverage, coordination-of-benefits, or other discrepancies requiring resolution before or during billing follow-up.
• Communicate timely and accurately with CDM faculty, residents, staff, and students regarding billing, insurance, and patient account issues.
• Prepare routine and ad hoc reports related to missing charges, charge review, unapproved charges, payment activity, accounts receivable, and billing trends.
• Assist leadership with escalated and complex patient account matters by researching account history, claims, payments, adjustments, documentation, and other relevant information and coordinating resolution.
• Serve as a resource and point of contact for CDM faculty, staff, and students regarding coding, billing, patient accounts, and related policies and procedures.
• Provide guidance and support regarding billing and coding processes, account resolution, and applicable CDM/MUSC procedures.
• Provide professional and courteous customer service to patients, responsible parties, payers, faculty, staff, and students while addressing billing questions, account concerns, insurance issues, and payment-related inquiries.
• Participate in assigned special projects, process-improvement initiatives, workflow development, and training activities.
• Perform other duties as assigned.

Minimum Requirements

A high school diploma and three years professional experience in a related area such as accounting, auditing, finance or commercial lending. A bachelor's degree with multiple accounting courses may be substituted for two years of the required work experience.

Additional Requirements

Computer literacy.