Dental Billing & Verification Specialist; US Healthcare

Position: Dental Billing & Verification Specialist (US Healthcare)
Location: Sabarmati

Job Title:

Dental Billing & Verification Specialist (US Healthcare)

Job Summary:

We are seeking a highly skilled and comprehensive  Dental Billing & Verification Specialist  to manage the end-to-end revenue cycle for our US-based dental practices. The ideal candidate will handle  everything from pre-appointment eligibility/benefit breakdowns to post-appointment claim submission, payment posting, and denial management . Your primary goal is to ensure clean claim submission, minimize revenue leakage, and accelerate the collection process.

Key Responsibilities:

1. Eligibility & Benefits Verification (EV-BV)

Insurance Verification:  Confirm active patient coverage and eligibility via insurance portals or direct phone calls  48 to 72 hours prior  to patient appointments.
Comprehensive Breakdowns:  Obtain detailed insurance breakdowns including  annual maximums, deductibles, frequencies, waiting periods, missing tooth clauses, and age limits .
System Updates:  Accurately update patient records and insurance fee schedules in the Dental Practice Management Software (PMS).

2. Claims Management & Billing

Claim Submission:  Generate and submit clean electronic and paper claims (with necessary attachments like  X-rays, periodontal charts, and narratives ) using  ADA claim forms .
Coding Compliance:  Audit clinical notes to ensure accurate application of  CDT (Current Dental Terminology) codes  and appropriate modifiers.
Coordination of Benefits (COB):  Correctly sequence and bill primary, secondary, and tertiary insurance plans.

3. Payment Posting & AR Follow-Up

Payment Posting:  Accurately post insurance payments from  Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs)  into patient accounts.
Denial Management:  Review, research, and appeal denied, rejected, or short-paid claims in a timely manner.
Accounts Receivable (AR):  Monitor aging AR reports, follow up with insurance payers on outstanding claims, and handle patient billing inquiries professionally.

Required Skills &

Qualifications:

Experience:

Minimum  1 to 3 years of hands-on experience  in US Dental Billing and Verification.
Technical Knowledge:  Deep understanding of  PPO, HMO, DHMO, Medicaid, and Indemnity plans , alongside complete mastery of  CDT codes .
Software Proficiency:  Expert knowledge of dental billing platforms and clearinghouses (e.g.,  Dentrix, Eaglesoft, Open Dental, eCentral, Change Healthcare, or DentalXChange ).
Communication

Skills:

Excellent spoken and written English. Must have strong  negotiation and communication skills  for regular phone interactions with US insurance companies.
Compliance:  Strict adherence to  HIPAA guidelines  and protecting patient health information.

Work Requirements:

Shift Timing:  Alignment with  US business hours  (Eastern, Central, or Pacific time zones).