The CBO Specialist takes responsibility for revenue cycle functions that happen outside the patient flow experience, directly supporting practice staff from a centralized processing center. The 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.
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).
Responsibilities
Position 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 receivable related questions/requests from the field teams in a quick and efficient 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 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.
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.
Qualifications
Qualifications
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.
Minimum five years commercial insurance or Medicaid experience preferred.
Computer Skills:
Proficiency in a Microsoft Windows environment.
Proficiency with dental or medical software; Dentrix and/or EagleSoft preferred.
Core Competencies: To perform the job successfully, an individual should demonstrate the following competencies to perform the essential functions of this position.
High level of customer service orientation.
Ability to assess development needs of affiliated auxiliary practice staff.
Knowledge of accounting policies and practices necessary to understand impact of outstanding receivables (debit and credit).
Must possess strong skills in the areas of interpersonal communication, analysis, critical thinking, attention to detail, and multi-tasking.
Excellent verbal and written communication skills.
Ability to work independently and collaboratively within a team environment.
