OverviewPosition Summary: The CBO Senior Specialist takes responsibility for revenue cycle functions that happen outside the patient flow experience, directly supporting practice staff from a centralized processing center. The senior specialist provides expertise and gives advice to affiliated practice staff with the aim of optimizing Dental commercial insurance and Dental Medicaid participation, as well as effective and timely follow up of account receivable balances due from insurance and patients. In conjunction with the practices, they also address credit balances.They provide focused training and on-going assistance to practice staff and other support personnel to ensure practice level proficiency in plan administration, revenue maximization, and accurate receivable records. Additionally, the CBO Senior Specialist serves as a team lead for the Central Billing Office team, directly reporting to the CBO Manager, training new members of the CBO team, providing reports and metrics as requested. They take responsibility for having an overall familiarity and, through their liaison relationship with the practices, exert reasonable control over assigned outstanding accounts receivable (debit and credit).ResponsibilitiesPosition Duties and Responsibilities :
Daily, or as directed, batch process insurance claims for assigned practices. Further, works all claim issues through to clearinghouse resolution and acknowledgment of receipt by the payer.
Analyzes and handles exceptions flowing from payment posting. Adjustment handling per policy.
Responding to questions/requests from the field teams in a quick, efficient and professional manner, requiring keen understanding of plan policies and all revenue cycle functions. Including but not limited to: Enrollment, Eligibility &Verification, Claims Processing, Payment and adjustment posting, Insurance and Patient Accounts Receivable processes.
Troubleshooting and resolving practice issues related to plan policy, coverage; Dentrix, Eaglesoft and technological interfaces. Handles appropriate support requests along with other team members.
Is the first line of practice action for receivables status-ed by the outsource vendor. Acts as practice liaison for those issues requiring on-site assistance. Tracks issues through to resolution.
Analyzes outstanding patient balances, following assigned policy steps including monthly batch statement processing, any collection letters and, in some cases, coordination with outside collection agency.
Participates in corporate meetings, along with other departments, to keep abreast of important topics and projects that impact the CBO team. Serves as subject matter expert during these meetings and actively participates in conversations to inform colleagues of interdepartmental dependencies related to the team’s work, and to ascertain any further actions needed by the CBO.
Investigates credit balances, recommending resolution to assigned practices.
Keep abreast of all policy and coverage changes including reimbursement rules, and the laws and regulations governing billing and collection activities.
Ability to work independently and collaboratively within a team environment.
Log all daily tasks as well as practice calls and emails taken in Sales Force.
Perform other duties as new opportunities arise and/or are assigned.
Trains and serves as mentor and team lead to new members of the Central Billing Office team.
Serves as subject matter expert in all matters related to the Central Billing Office.
QualificationsQualifications
Ability to interpret and effectively communicate insurance regulations.
Excellent verbal and written communication skills.
Ability to facilitate telephone, in-person, and/or web-based training sessions.
Excellent problem-solving skills.
Well organized, accurate, and thorough.
Adaptable; readily adjusts work schedule to adhere to changes in the work environment and able to manage competing demands.
Adept at prioritizing, planning work activities, and developing reasonable action plans.
Proficiency in all Microsoft Office products.
Education and Experience Requirements:
Associate degree required; bachelor’s degree preferred. In lieu of education, 4 or more years of relevant experience.
Minimum 5-8 years commercial insurance or Medicaid experience preferred.
Experience working in a dental practice or in the dental field preferred.
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