GoTo Telemed
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.
Base pay range $45,000.00/yr - $250,000.00/yr
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 physical mail delivery
Prepare documentation for printing and mailing (claims, patient statements, appeals)
Maintain print‑to‑mail logs with tracking information
Verify mailing addresses and ensure HIPAA‑compliant delivery
Track delivery of critical documents using postal tracking when available
Requirements Compliance & Documentation
Maintain strict adherence to HIPAA Privacy, Security, and Breach Notification Rules
Ensure all patient communications comply with Telehealth Patient Rights and state‑specific requirements
Follow OIG compliance program guidelines including exclusion list checks (HHS OIG LEIE database)
Document all billing activities, communications, and decisions in patient records
Maintain confidentiality of patient Protected Health Information (PHI) at all times
Comply with state‑specific teledentistry and telehealth billing regulations
Report potential compliance concerns through established compliance channels
Reporting & Analytics
Generate daily, weekly, and monthly revenue cycle reports including:
Days in Accounts Receivable (DAR) by payer
Claim submission rates and approval rates
Denial rates and denial reasons
Collection rates and aging AR analysis
Payment posting timeliness
Identify trends and opportunities for process improvement
Communicate financial metrics to management and clinical teams
Track Key Performance Indicators (KPIs) including collection rates, claim approval rates, and AR aging
Required Qualifications & Skills Education & Certification
High school diploma or GED required
Formal training in dental billing, medical billing, healthcare administration, or related field strongly preferred
Current certification in one of the following preferred:
Certified Professional Biller (CPB) through AAPC
Certified Dental Coder (CDC) through AADC
Certified Medical Reimbursement Specialist (CMRS)
Registered Health Information Technician (RHIT)
Current knowledge of CDT codes and ICD‑10 coding standards
Technical Skills
Advanced proficiency with Microsoft Office Suite (Excel, Word, Outlook)
Proficiency with practice management software and Electronic Health Record (EHR) systems
Ability to navigate insurance company portals and claim submission systems
Experience with dental coding software and/or encoder systems
Strong data entry and computer literacy skills
Familiarity with HIPAA‑compliant communication platforms and secure messaging
Compliance & Regulatory Knowledge
Comprehensive understanding of HIPAA Privacy Rule, Security Rule, and Breach Notification Rule
Working knowledge of OIG Anti‑Kickback Statute, Stark Law, and exclusion list compliance
Understanding of state‑specific telehealth/teledentistry regulations and billing requirements
Knowledge of CMS telehealth policies and modifier requirements (modifiers 95, GT, FQ, FR)
Familiarity with CDT and CPT coding standards for dental procedures
Understanding of medical billing basics for surgical/medical procedures billed with medical insurance
Soft Skills & Competencies
Attention to Detail: Exceptional accuracy in data entry, coding, and claims management with ability to spot and correct errors
Communication: Strong written and verbal communication skills for professional interaction with patients, insurance companies, and internal teams
Problem‑Solving: Ability to investigate claim denials, identify root causes, and implement solutions
Time Management: Ability to prioritize multiple tasks and meet established deadlines
Customer Service: Patient, professional demeanor when handling sensitive billing questions and collection calls
Organization: Ability to maintain accurate records and manage complex workflows
Analytical Thinking: Ability to interpret EOBs, identify trends, and recommend process improvements
Professionalism: Ethical conduct and unwavering commitment to compliance and patient confidentiality
Adaptability: Ability to learn new systems and adjust to evolving payer policies and regulations
Compliance & Background Requirements
OIG Exclusion List Check: Candidate will be checked against HHS OIG LEIE database before hire and periodically during employment
Background Check: Standard criminal background check required per healthcare industry standards
HIPAA Compliance Training: Mandatory HIPAA certification and compliance training required before hire and annually thereafter
Exclusion List Monitoring: Candidate must comply with periodic re‑verification against HHS OIG Exclusion List and state‑specific exclusion databases
Professional Conduct: Commitment to ethical billing practices, compliance with fraud and abuse laws, and adherence to state dental practice regulations
License Verification: If applicable to the state, candidate must maintain any required healthcare administrative licenses
Seniority level
Entry level
Employment type
Full‑time
Job function
Other
Industries
IT Services and IT Consulting
#J-18808-Ljbffr
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.
Base pay range $45,000.00/yr - $250,000.00/yr
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 physical mail delivery
Prepare documentation for printing and mailing (claims, patient statements, appeals)
Maintain print‑to‑mail logs with tracking information
Verify mailing addresses and ensure HIPAA‑compliant delivery
Track delivery of critical documents using postal tracking when available
Requirements Compliance & Documentation
Maintain strict adherence to HIPAA Privacy, Security, and Breach Notification Rules
Ensure all patient communications comply with Telehealth Patient Rights and state‑specific requirements
Follow OIG compliance program guidelines including exclusion list checks (HHS OIG LEIE database)
Document all billing activities, communications, and decisions in patient records
Maintain confidentiality of patient Protected Health Information (PHI) at all times
Comply with state‑specific teledentistry and telehealth billing regulations
Report potential compliance concerns through established compliance channels
Reporting & Analytics
Generate daily, weekly, and monthly revenue cycle reports including:
Days in Accounts Receivable (DAR) by payer
Claim submission rates and approval rates
Denial rates and denial reasons
Collection rates and aging AR analysis
Payment posting timeliness
Identify trends and opportunities for process improvement
Communicate financial metrics to management and clinical teams
Track Key Performance Indicators (KPIs) including collection rates, claim approval rates, and AR aging
Required Qualifications & Skills Education & Certification
High school diploma or GED required
Formal training in dental billing, medical billing, healthcare administration, or related field strongly preferred
Current certification in one of the following preferred:
Certified Professional Biller (CPB) through AAPC
Certified Dental Coder (CDC) through AADC
Certified Medical Reimbursement Specialist (CMRS)
Registered Health Information Technician (RHIT)
Current knowledge of CDT codes and ICD‑10 coding standards
Technical Skills
Advanced proficiency with Microsoft Office Suite (Excel, Word, Outlook)
Proficiency with practice management software and Electronic Health Record (EHR) systems
Ability to navigate insurance company portals and claim submission systems
Experience with dental coding software and/or encoder systems
Strong data entry and computer literacy skills
Familiarity with HIPAA‑compliant communication platforms and secure messaging
Compliance & Regulatory Knowledge
Comprehensive understanding of HIPAA Privacy Rule, Security Rule, and Breach Notification Rule
Working knowledge of OIG Anti‑Kickback Statute, Stark Law, and exclusion list compliance
Understanding of state‑specific telehealth/teledentistry regulations and billing requirements
Knowledge of CMS telehealth policies and modifier requirements (modifiers 95, GT, FQ, FR)
Familiarity with CDT and CPT coding standards for dental procedures
Understanding of medical billing basics for surgical/medical procedures billed with medical insurance
Soft Skills & Competencies
Attention to Detail: Exceptional accuracy in data entry, coding, and claims management with ability to spot and correct errors
Communication: Strong written and verbal communication skills for professional interaction with patients, insurance companies, and internal teams
Problem‑Solving: Ability to investigate claim denials, identify root causes, and implement solutions
Time Management: Ability to prioritize multiple tasks and meet established deadlines
Customer Service: Patient, professional demeanor when handling sensitive billing questions and collection calls
Organization: Ability to maintain accurate records and manage complex workflows
Analytical Thinking: Ability to interpret EOBs, identify trends, and recommend process improvements
Professionalism: Ethical conduct and unwavering commitment to compliance and patient confidentiality
Adaptability: Ability to learn new systems and adjust to evolving payer policies and regulations
Compliance & Background Requirements
OIG Exclusion List Check: Candidate will be checked against HHS OIG LEIE database before hire and periodically during employment
Background Check: Standard criminal background check required per healthcare industry standards
HIPAA Compliance Training: Mandatory HIPAA certification and compliance training required before hire and annually thereafter
Exclusion List Monitoring: Candidate must comply with periodic re‑verification against HHS OIG Exclusion List and state‑specific exclusion databases
Professional Conduct: Commitment to ethical billing practices, compliance with fraud and abuse laws, and adherence to state dental practice regulations
License Verification: If applicable to the state, candidate must maintain any required healthcare administrative licenses
Seniority level
Entry level
Employment type
Full‑time
Job function
Other
Industries
IT Services and IT Consulting
#J-18808-Ljbffr