RCM Quality Specialist

Revenue Cycle Quality Specialist

The Revenue Cycle Quality Specialist is responsible for monitoring and analyzing dental practice adherence to revenue cycle related policies and processes. The role will audit, compile, and report on various Revenue Cycle and Operations related metrics.

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SALARY RANGE: $22-$24

BONUS ELIGIBLE: No

BENEFITS: We offer a comprehensive benefits package designed to support your health and financial well-being. Benefits include:

• Health Insurance: Medical, Dental, and Vision coverage.
• Paid Time Off (PTO): Yes
• Retirement Plan: 401(k)

ESSENTIAL JOB RESPONSIBILITIES

• Monitor and audit practice compliance with Revenue Cycle policies and processes
• Review, question, and apply Miscellaneous Discretionary Credit Adjustments for specific Elite Dental Partner practice locations.
• Review and post insurance refunds to practice location patient ledgers processed by Elite Dental Partners Accounts Payable Department on a weekly basis.
• Pull, compile and report operational and quality metrics related to the Revenue Cycle and operational processes.
• Investigate patient ledgers, as necessary, for accuracy and modify as required.
• Ensure compliance with HIPAA and other relevant Federal and state regulatory requirements
• Complete and send Days to Claim Sent Report to operations on a weekly basis, usually by end of day on Friday.
• Compile Unsent Claims data and reviews Credentialing holds and compares them to the Delta Toolkit.
• Pulls guarantor payments for Dentrix Core and Dentrix Ascend for private pay analysis for month-end.
• Assist with incomplete treatment reversals / adjustments as required.
• Presents on Regional Manager and Office Manager Onboarding Calls on revenue cycle topics such as: SharePoint Requests, Adjustment Policy, EDP Employee and Family Discount, insurance refund process, reporting and special requests.
• Provides end of year financial audit support and facilitates the pulling of patient ledgers for external audit sample completion.

OTHER JOB RESPONSIBILITIES

• Provide feedback on process improvement opportunities
• Work with Revenue Cycle, Operations and Finance teams on ad-hoc report requests
• Complete projects and ensure deliverables and timelines are met
• Provide clear and concise updates on ongoing projects, calling out risks

Qualifications:

• Excellent communication skills, both written and verbal. Ability to interact at all organizational levels.
• Strong problem-solving skillset.

• Self-starter who excels in a fast paced, data driven environment.
• Must be proficient in MS Office tools

REQUIRED EDUCATION AND EXPERIENCE:

• High School diploma or equivalent required. Associates degree preferred
• 3-5 years dental billing experience preferred with knowledge of claim submission process
• Strong Microsoft Excel skills required

PHYSICAL REQUIREMENTS:

General Office Activities as Required

The above statements are intended to provide a general overview and level of work being performed by most people assigned to this job. They are not intended to be a list of all responsibilities, duties and requirements. Additional duties can be assigned as determined.

Elite Dental Partners is an Equal Opportunity/Affirmative Action Employer. We support a diverse workforce.

We take great pride in helping our communities be healthier, feel better, and smile with confidence. Daily, we are driven by our vision to provide an elite patient experience tailored to their needs to receive the best care possible.

Not only do our team members find it rewarding to help patients be healthier, but they also enjoy being part of an organization that supports their growth. Our commitment to professional development and promoting internally when appropriate allows for tremendous career opportunities.

Originally posted on Himalayas