Great at multi-tasking. Headline : Dedicated Medical Billing Specialist with 6 years of experience processing medical insurance claims. Ensures required authorization of, Education: Associate's Degree or some college, Field of Expertise: working knowledge of dental management systems, preferably axiUm. Outstanding written and verbal communication skills. Designed and implemented the first banking reconciliation spreadsheet for practice to more effectively and accurately reflect out the daily deposit. Prepares solutions. Download Dental Resume Sample as Image file, Registered Dental Assistant Resume Sample, Grievance and Appeals - the Plan Dental Director maintains an active liaison with UCS G&A, reviews dental and medical/dental cases, and is responsible for representing the Local C&S plan at State-level Fair Hearings as requested, Oversee dental policy development and administration. Communicating and performing follow up with insurance companies and vendors on patient accounts in a timely manner in compliance with HIPAA regulations. Experience in consumer-side healthcare environment, Demonstrates bilingual skills in English and Spanish (written and verbal), Experience working in a healthcare and/or dental environment, Demonstrated excellent verbal communication and telephone skills with patients and their family members, Experience in a high volume, fast paced environment, Demonstrated team-oriented and collaborative work style, Working knowledge of Microsoft Office Word and Excel, Working experience in an orthodontic office, Working knowledge of dental management computer systems, preferably axiUm, Past work experience in patient / family communication responsibilities in a front office medical or dental position, Skills: answer phones, assemble and organize numerical data, balance figures, clinical documentation, communicate with others to gather information, compute totals, customer service, maintain filing systems, prioritize different projects, schedule appointments, understand and apply policies and procedures, use database and/or word processing software, verify calculations. Dental assistants also must be able to take X-rays, blood pressure readings, and dental impressions, prepare dental materials, maintain equipment, and disinfect rooms and tools. Unpacks and stocks shelves to predetermined levels, Controls supply of lab coats. Provide scheduling support for RDH schedules, Ensure all dental records are available according to updated printed schedule. All aspects of billing, … Carrying the sole responsibility for the two largest aged accounts, Medicare and Anthem Blue Cross Blue Shield as well as assisting the department with the remaining commercial par and non-par accounts. Capable of working and communicating well in a matrixed environment with Dental Directors, Sales, Dental Provider Relations; National Appeals Unit, Credentialing, Legal, Policy and Compliance, Healthcare, Service Operations, Marketing; as well as state regulators and auditors, Excellent oral and written communication skills are required, Must be detail oriented, highly organized, deadline driven, and self-motivated, Must possess project management expertise with demonstrated experience in managing multiple projects and priorities, Skilled in the use of Microsoft PowerPoint, Word, Excel, and Outlook, Excellent analytical, quantitative, and problem solving skills, Capable of quickly learning and mastering the intricacies of a variety of IT systems, Experience in the various aspects of a strong Quality Management Program, Strong background in the Credentialing and Recredentialing of dentists, Knowledge of NCQA and other medical/dental quality standards and state specific regulations regarding quality programs, Command of dental terminology, clinical procedures, and benefit language, Financial acumen for assisting in financial analysis. Summary : Detail oriented Billing Specialist with professionally focused training for Medical Billing and Coding. The plan Dental Director has shared accountability for HEDIS performance for the Local C&S plan for Dental measures. Confirming if a person is a current patient at the medical office, confirming if a patient was seen by a primary care physician on a particular date, when a secondary insurance company calls about a primary EOB that is not legible or missing, provide the correct EOB information for the claim to be processed correctly. Collecting the correct insurance information in order for the claim to be submitted to the patient's current insurance carrier and update the patient's insurance information in the system. Resume Text. Generated invoices upon receipt of billing information and tracked collection progress. Skills : Customer Service, Medical Coding, Medical Billing, Medical Terminology, Medical Records, Accounts Receivable, Reconciliation, How to write Experience Section in Banking Resume, How to present Skills Section in Banking Resume, How to write Education Section in Banking Resume. Able to direct and lead others to produce desired results. Significantly reduced denials for skilled nursing facility charges by over 65%. Additionally the Plan Dental Director, working with dental staff, has primary responsibility to oversee new clinical model operations where appropriate, including Person-Centered Care Models (PCCM), (Accountable Care Community/ACC) relationships, and new Models of Care programs such as those defined by AHCCCS, DDD and/or the Center for Medicare and Medicaid Services (CMS). ), Monitor staff job expectations and assigned duties, Assign and monitor daily employee assignments, Train, orient, mentor and evaluate staff as needed, Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Health Choice employee, Ensure that decisions are made in compliance with contractual and HCA guidelines, Ensure staff are properly trained in all aspects and systems of departmental processes, Ensure fraud, waste and abuse concerns are identified and reported in a timely manner, Ensure accurate departmental statistics, to include daily updates as required, Ensure all additional duties assigned by the Oral Health Manager, are completed in a responsive and timely manner, Ensure employees are fulfilling day to day performance standards, Ensure prior authorizations are completed in accordance with AHCCCS and URAC standards, Ensure daily productivity expectations are attained, Ensure employee concerns related to job performance are addressed, Ensure delegated duties are completed in a timely manner, Ensures staff productivity is monitored and additional work is assigned as needed, Ensures Desktops are reviewed for consistency and accuracy, Ensures staff is trained on updated processes prior to implementation, Ensures technical expertise is maintained and acts as the point of contact, when Oral Health Management is not available, Ensures the Dental Prior Authorization Desk reference is updated and current at all times, Strong working knowledge of State Medicaid programs, Read, write and orally communicate at a professional level, Ability to work independently and as part of a dynamic team, At least two (3) years or experience with Medicaid dental benefits preferred, At least five (5) years of dental practice experience (required), Intermediate to Advanced knowledge of Microsoft Office applications (i.e. Verifying that billed medical services, diagnostic tests and medications were supported by the patients' diagnoses before sending claims to carriers. 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