| Job Description: |
Patient Financial Counseling & Insurance Coordination. Interview and counsel all patients in the Dental Center to determine their financial status and/or insurance coverage and advise them of available federal and state financial aid programs. Review insurance policies to determine deductible, co-payment, and extent of coverage. Submit and review pre-authorizations for all insurances, ensuring accurate processing through Axium, and communicate with patients to schedule appointments once pre-authorizations are completed. Process and track pre-authorizations received via fax in Axium, following up as necessary. Assist patients as needed in establishing payment method for proposed treatment before treatment begins (i.e., cash payments, contracts, loans from financial institution such as Lending Club, credit card payments, Capital One Dental Fee Plan, etc.). Review patient accounts in Axium to ensure accuracy of dues and communicate with the CSR’s team on appropriate copayments and balances to be collected at the time of services. Ensure all financial obligations are properly reflected to maintain accurate patient billing and minimize outstanding balances. Monitor Citrus- Ryan White program, ensuring compliance with program requirements and assisting eligible patients in coordination of care. Work on schedules keeping production and efficient patient flow. Maintain ongoing contact with patients throughout treatment to assist with payment issues, verify timely payments, and intervene on their behalf with third-party payers. Process and follow up on any third-party or agency claims, including denials, and take necessary steps for resolution. Perform adjustments in patients accounts as needed, ensuring accuracy in financial transactions. Work with members of the COD Business Office to collect balances, process claims, troubleshoot reimbursement problems, and maintain compliance with payer contracts. Patience grievance resolution, working closely with the CSRs and clinical teams to address concerns efficiently.
Insurance, Billing, & Financial Support. Serve as the Hialeah Dental Center’s primary contact for all reimbursement, insurance, coding, and billing issues. Address inquiries related to billing, reimbursement, dental insurance, Medicaid dental benefits, and other payment-related concerns. Maintain up-to-date knowledge in these areas and provide clear and appropriate information. Maintain updated patient information and documentation in Axium. Actively communicate with faculty, residents, and CSRs to provide real-time updates on patients’ financial status, particularly as it impacts treatment planning. Respond to faculty/resident/CSR requests for payment issue resolutions and provide timely updates on efforts towards resolution. Monitor upcoming patient schedules to determine outstanding balances, discuss collection options, and coordinate resolution prior to appointments. Ensure that appointments are booked accurately in Axium, aligning with treatment needs, financial approvals, and provider availability. Manage the Working Aged Report and coordinate collections efforts accordingly.
Medicaid & Insurance Quality Assurance Oversight. Provide QA oversight and analysis of Medicaid and Insurance billing to ensure accuracy in initial and subsequent billings. Verify that distributions between patient payments and insurance reimbursements are correctly allocated. Identify process improvements to enhance billing accuracy and patient service.
Collections & Account Management. Utilize accounts receivable reports to follow collection procedures, including patient and guarantor outreach, generating collection letters, and documenting collection actions. Report collection outcomes to the manager and COD Business Office. Determine which accounts should be referred to an outside collection agency and submit accounts for write-offs or further follow-up. Analyze monthly aging reports and document relevant notes on patient accounts.
Front Desk & Administrative Support. Provide support for the front desk reception and answer clinic telephones as needed. Work collaboratively with the front desk team to confirm that all financial obligations are addressed before scheduling appointments. Ensure that appointments are scheduled accurately to support clinical production goals while maintaining an optimal patient experience. Act as a treatment layer of support for atypical cases, assisting in financial planning and coordination. Coordinate care for patients enrolled in financial assistance programs, ensuring they receive necessary approvals and access to treatment without delay
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