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About the Role
The Fee Schedule Administrator is responsible for the accuracy, integrity, and ongoing maintenance of dental fee schedules. This role will research, validate, implement, and audit fee schedule configurations to ensure alignment with contracted reimbursement and payer adjudication, working closely with cross-functional partners to identify and resolve reimbursement discrepancies.
Responsibilities
- Administer and maintain dental fee schedules across multiple practices, payers, plans, and networks.
- Independently research, validate, and implement fee schedule corrections within the practice management system, maintaining appropriate documentation.
- Audit existing fee schedules against contracted reimbursement terms, payer documentation, and historical adjudication.
- Investigate discrepancies between expected reimbursement and actual payer adjudication to identify potential issues.
- Evaluate identified discrepancies for broader impact across offices, payers, plans, and procedure codes.
- Partner cross-functionally with Payer Relations, Credentialing, RCM, and other internal teams to obtain and validate necessary documentation.
- Develop and maintain proactive processes for identifying fee schedule discrepancies and reimbursement variances.
- Establish routine auditing and monitoring practices to support ongoing fee schedule accuracy.
- Perform root-cause analysis of recurring fee schedule and reimbursement variances and implement corrective actions.
- Maintain clear records of fee schedule updates, effective dates, affected parties, supporting documentation, and completed corrections.
- Quantify and report identified variances and financial impact, including trends and opportunities for revenue recovery.
- Support fee schedule review, validation, and configuration associated with new practice acquisitions, payer changes, new contracts, and organizational growth.
- Serve as an internal subject-matter resource regarding dental fee schedules, reimbursement configuration, and related payer adjudication issues.
- Support additional Revenue Cycle Management functions and special projects as needed.
Requirements
- Demonstrated experience administering dental fee schedules within a dental practice management system.
- Strong working knowledge of dental insurance reimbursement, PPO fee schedules, contracted allowances, downgrades/alternate benefits, payer adjudication, and common dental reimbursement methodologies.
- Experience researching reimbursement discrepancies using fee schedules, contracts, EOBs/ERAs, claims, and practice management system data.
- Ability to independently research unfamiliar reimbursement or system issues, identify root cause, and implement accurate solutions with minimal oversight.
- Ability to distinguish between fee schedule/configuration issues and other causes of reimbursement variance.
- Strong attention to detail with the ability to manage high-volume data while maintaining accuracy.
- Strong organizational and documentation skills.
- Ability to collaborate effectively across RCM, Payer Relations, Credentialing, Operations, and other functional teams.
- Strong Excel skills, including the ability to organize, reconcile, filter, and analyze reimbursement and fee schedule data.
- Ability to prioritize competing needs and work independently in a remote environment.
Skills
- Denticon experience strongly preferred
- Excel skills
Location
- remote
Work Type
- remote
Salary/Compensations
- $30/HR - $35/HR
Benefits
- Flexible Health and Vision Insurance Plans
- 401(K) Retirement Plan with Matching
- Generous Paid-Time Off (up to 3 weeks plus an annual 'you' day)
- Exclusive In-house Dental Program (heavily discounted services)
- Extra Perks and Fringe Benefits
About the Company
- A modern practice environment designed for superior care and comfort, embracing cutting-edge technology in a soothing environment.
- A team that supports your success, emphasizing health over sales, cultivating a warm, supportive culture without the pressure of production quotas.
- Encourages and supports growth in careers.
Equal Opportunity
- 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.
- Proud to promote a work environment where all differences are respected.