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About the Role
The Medical Billing & AR Specialist is responsible for managing medical billing activities related to dental procedures, including claim submission, pre-authorizations, claim follow-up, denial resolution, and appeals. This role will also support dental insurance accounts receivable follow-up and other Revenue Cycle Management functions. The position requires strong knowledge of dental-to-medical billing and the ability to independently manage claims from submission through resolution. The specialist will identify and report recurring denial and reimbursement trends, determine root causes, and provide feedback to improve first-pass payment and reduce rework. The role also supports the development and maintenance of documented internal medical billing workflows.
Responsibilities
- Prepare and submit medical claims for eligible dental and oral procedures, ensuring accurate coding, required documentation, and payer-specific requirements are met.
- Manage medical pre-authorizations from initial submission through determination, including obtaining necessary clinical documentation, responding to requests for additional information, and performing timely follow-up.
- Perform follow-up on outstanding medical claims through final resolution, including payer outreach, corrected claims, reconsiderations, denials, appeals, and additional documentation requests.
- Review rejected and denied claims to determine root cause and take appropriate corrective action.
- Identify, track, and report recurring denial and reimbursement trends, including payer-specific patterns, documentation deficiencies, authorization issues, coding concerns, and other barriers to first-pass payment.
- Proactively escalate identified trends and recommend corrective actions designed to prevent recurrence and improve reimbursement outcomes.
- Work assigned dental insurance AR, including outstanding claims, denials, appeals, corrected claims, and other follow-up activities as organizational priorities and capacity require.
- Prioritize assigned AR based on aging, financial impact, timely filing requirements, payer response, and other established RCM standards.
- Maintain complete and accurate documentation of claim status, payer communication, actions taken, supporting documentation, and required next steps.
- Monitor claims through adjudication and ensure appropriate reimbursement or final disposition.
- Partner with clinical, operational, RCM, and other internal teams to obtain information necessary for claim submission, authorization, appeal, and resolution.
- Maintain accurate, current documentation of medical billing, pre-authorization, and follow-up workflows to support operational continuity, cross-training, and consistent execution.
- Participate in the development and improvement of processes designed to increase clean claim performance, first-pass payment, and overall AR resolution.
- Support additional Revenue Cycle Management functions and special projects as needed based on organizational priorities and business needs.
Requirements
- Demonstrated experience with medical billing for dental and/or oral procedures required.
- Experience with medical claim submission, medical pre-authorizations, claim follow-up, denials, appeals, and reimbursement resolution.
- Demonstrated experience working dental insurance accounts receivable required, including claim follow-up, denial resolution, corrected claims, appeals, and aging AR.
- Strong understanding of medical and dental insurance reimbursement processes and payer requirements.
- Experience interpreting EOBs/ERAs, payer responses, denial reasons, authorization requirements, and supporting clinical documentation.
- Denticon experience strongly preferred. Candidates with significant dental-to-medical billing expertise and demonstrated ability to quickly learn complex practice management systems will also be considered.
- Familiarity with medical claim forms, coding requirements, and documentation standards applicable to dental procedures billed to medical insurance.
- Ability to independently research claim and reimbursement issues, determine root cause, and drive claims through resolution with minimal oversight.
- Strong attention to detail and ability to manage a high-volume workload while maintaining accuracy.
- Strong organizational, prioritization, and documentation skills.
- Strong Excel skills, including the ability to organize, filter, reconcile, and analyze claim and reimbursement data.
- Ability to identify patterns and translate claim-level findings into actionable trends and recommendations.
- Ability to collaborate effectively across RCM, clinical, operational, and other functional teams.
- Ability to work independently and effectively in a remote environment.
Skills
- Medical billing
- Dental billing
- Claim submission
- Pre-authorizations
- Claim follow-up
- Denial resolution
- Appeals
- Accounts receivable
- Revenue Cycle Management
- Excel
- Denticon
Location
- Remote
Work Type
- Remote
- Full-time
Experience Level
- Mid-level
Salary/Compensations
- $26/HR - $28/HR
Benefits
- Flexible Health and Vision Insurance Plans
- 401(K) Retirement Plan with Matching
- Generous Paid-Time Off (up to 3 weeks)
- Annual 'you' day for self-care
- Exclusive In-house Dental Program (heavily discounted services)
- Extra Perks and Fringe Benefits
- Incredible work environment
- Opportunity for massive growth
About the Company
- PCDM is a modern practice environment designed for superior care and comfort, embracing cutting-edge technology in a soothing environment.
- The company focuses on patient experience, communication, and care.
- PCDM fosters a warm, supportive culture without the pressure of production quotas, emphasizing health over sales.
- The company supports and encourages career growth.
- PCDM celebrates diversity and promotes a work environment where all differences are respected.
Equal Opportunity
- PCDM provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, sexual orientation, gender identity, or gender expression in terms of all conditions of employment.
- As an Equal Opportunity Employer, PCDM is proud to promote a work environment where all differences are respected.