Sculpt Center for Implants & Periodontics is a premier periodontal and dental implant practice dedicated to providing top-tier care and exceptional patient experiences. We are currently seeking a Dental Billing & Insurance Specialist to join our administrative team. This key position plays an essential role in managing insurance claims, billing processes, and ensuring that our patients' financial concerns are handled efficiently and professionally. The ideal candidate will possess strong knowledge of dental insurance protocols, a keen eye for detail, and the ability to manage patient accounts effectively. Key Responsibilities Insurance Verification and Authorization • Insurance Verification • Verify patient insurance benefits and eligibility prior to treatment to ensure coverage for periodontal and implant services. • Communicate directly with insurance companies to clarify coverage, patient eligibility, and out-of-pocket responsibilities. • Maintain accurate insurance information in the practice management system. • Pre-Authorization and Pre-Determination • Obtain pre-authorizations or pre-determinations for major treatments (e.g., surgical procedures, implants, periodontal therapies) to ensure insurance approval before treatment begins. • Submit insurance claims and follow up with insurance companies for claim status updates and resolve any issues or discrepancies. Claim Submission and Follow-Up • Insurance Claims Submission • Submit accurate and timely insurance claims for all procedures performed at the practice, ensuring all necessary documentation is included. • Process claims through various insurance carriers, including PPOs, HMOs, Medicaid, and any other insurance plans accepted by the practice. • Claim Denials and Appeals • Investigate and follow up on denied or rejected claims, ensuring that all coding and documentation is correct and that any discrepancies are promptly addressed. • Submit appeal letters and necessary documentation to insurance carriers to resolve denied claims or underpayments. • Claim Reconciliation • Review insurance payments, EOBs (Explanation of Benefits), and payment remittances to ensure proper reimbursement for services rendered. • Reconcile insurance payments and apply them accurately to patient accounts. • Ensure proper adjustments are made to patient balances based on insurance payments or denials. Billing and Payment Processing • Patient Billing • Generate patient billing statements for any outstanding balances, including co-pays, deductibles, and non-covered services. • Work with patients to provide clarity on outstanding balances and offer payment plans or financing options when necessary. • Process payments from patients via checks, credit cards, or other payment methods. • Patient Financial Communication • Communicate with patients regarding their financial responsibilities, including insurance coverage, treatment estimates, and outstanding balances. • Provide clear and empathetic responses to patient inquiries related to billing, insurance claims, or payment options. • Payment Plans and Collections • Set up and monitor payment plans for patients, ensuring timely follow-Gigentra on any overdue balances. • Work with patients to establish affordable payment options and ensure accounts are kept current. • Escalate accounts to collections when necessary and in accordance with practice policies. Account Management and Documentation • Account Reconciliation • Regularly review patient accounts for accuracy, ensuring that all charges, payments, and adjustments are properly documented. • Track outstanding claims and payments and maintain accurate records of all billing and insurance transactions. • Update patient accounts in the practice management system to reflect the correct insurance information, payment history, and balance. • Maintain Documentation • Maintain detailed records of insurance claims, EOBs, patient communications, and payment history to ensure proper documentation of all billing activities. • Prepare reports for management on outstanding accounts, collections, and insurance reimbursements. Compliance and Reporting • HIPAA and Compliance Standards • Ensure all billing and insurance activities comply with HIPAA regulations, patient confidentiality requirements, and practice policies. • Stay updated on changes in dental billing codes, insurance carrier policies, and state/federal regulations impacting billing and reimbursement. • Reporting and Audits • Assist in the preparation of financial reports, including aging reports, insurance receivables, and collections reports. • Participate in internal audits of billing processes and accounts to ensure compliance with regulatory standards and to identify areas for improvement. Qualifications Required Qualifications • Experience: • Minimum of 2-3 years of experience in dental billing and insurance verification, preferably in a periodontal or specialty practice setting. • Experience working with a variety of insuran