Position Purpose:

The Oral Surgery Billing Specialist is responsible for managing the billing and reimbursement process for oral surgery procedures. This may include verifying insurance coverage, coding claims accurately, submitting claims, following up on unpaid claims, and ensuring timely payments. The ideal candidate will have a strong understanding of oral surgery billing practices, dental and medical insurance processes, and exceptional attention to detail.

Responsibilities:

• Insurance Verification and Coordination:
  • Verify patient insurance eligibility and benefits before procedures.
  • Obtain prior authorizations for oral surgery procedures when needed.
  • Coordinate benefits between medical and dental insurance plans.
• Claims Submission and Management:
  • Accurately verify codes and submit claims using ICD-10, CPT, and CDT codes.
  • Ensure compliance with payer guidelines and regulatory requirements.
  • Resolve discrepancies or denials in a timely manner.
• Accounts Receivable Management:
  • Monitor aging reports and follow up on outstanding claims.
  • Communicate with insurance companies to resolve claim issues or delays.
  • Post insurance payments and adjustments accurately.
• Patient Billing and Communication:
  • Prepare and send patient statements for balances owed.
  • Help to handle patient billing inquiries and explain charges or insurance denials.
• Documentation and Reporting:
  • Maintain accurate records of billing activities and insurance correspondence.
  • Generate regular reports on accounts receivable, claims status, and payment trends and report those to practice leader and RCM advisor.

 Qualifications:

Education/Certification:

• High School Diploma or equivalency, required.
• Associate’s degree or certification in medical/billing or coding, preferred.

Experience:

• Minimum of 1 year of experience in dental or medical billing (Dental or oral surgery experience preferred).
• Knowledge of ICD-10, CPT, and CDT coding.
• Familiarity with dental/medical billing software (e.g., WinOMS, DSN, Sensei, etc).
• Knowledge of medical and dental insurance processes, including coordination of benefits.

Performance Requirements:

• Strong organizational skills
• Excellent communication and customer/patient-service capabilities.
• Ability to handle multiple tasks
• Ability to work in fast-paced environment
• Analytical and detail-oriented
• Able to work independently with exceptional initiative and sound judgment
• Ability to handle sensitive information confidentially.
• Positive attitude, change advocate, able to lead by example

DISCLAIMER

The above statements are intended to describe the general nature and level of the work being performed by people assigned to this work.  This is not an exhaustive list of all duties and responsibilities.  OPS’s management reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.