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(Archived) Insurance Payment Processor

Last Updated: 3/25/21

Job Description

Company Overview: Job Description:

Smile Brands, a three-time Glassdoor Best Place to Work, is seeking an Insurance Payment Processor to join our team. The ideal candidate will be able to work in a fast-paced environment, is able to multi-task or switch focus easily, and has experience reading an EOB or patient account.

Essential Duties and Responsibilities

  • Post insurance payments and insurance supplement payments
  • Post all insurance payments within 48 hours of receipt and prior to month end close
  • Post insurance capitation payments and capitation revenue
  • Setup and maintain capitation payment accounts following standard guidelines for account name, account type, and insurance record
  • Monitor capitation payment accounts to ensure balance remains zero (both patient and insurance)
  • Monitor capitation trends data to ensure capitation transactions posted correctly
  • Monitor capitation dollar trends by office and plan to confirm receipt of capitation payments; follow-up on missing payments to resolution
  • Monitor capitation dollar trends by office and plan; notify director/manager of significant changes in capitation due to plan changes or employer group changes
  • Post unidentified payments to appropriate account (annual); include appropriate documentation and maintain file of all unidentified payments
  • Research unidentified payments and resolve issues within 30 days of receipt.
  • Post patient statement and collection letter payments
  • Post ACH payments
  • Generate secondary claim upon receipt of primary payment and attached primary insurance carrier Explanation of Benefits (EOB)
  • Adjudicate claim payments and process adjustment per insurance carrier Explanation of Benefits (EOB) up to approved amounts.
  • Write up adjustments over approved amounts and provide to manager for review and approval
  • Enter notes in patient’s ledger and claim systems; providing details regarding payment denial, short pay or patient copay responsibility
  • Copy part paid EOB’s requiring appeal and distributed to insurance collectors.
  • Scan payment EOB (Explanation of Benefits), confirm readable and searchable; store in folder for dental office and billing office access.
  • Copy all part paid EOB’s for collections to appear and notate in ,29X
  • Balance and prepare deposits and cash audit reports
  • Assist mail team when required
  • Check Apex for Posting Errors
  • Provide copies of $250 balances flipped to patient balance and record on Excel spreadsheet for Manager.
  • Required to work late on last business week of the month to post all payments before QSI closeout. If end of month falls on a Saturday, Monday or Tuesday we work the last Saturday of the month.
Required Qualifications:

Essential Skills

  • Complete understanding of Adjudication of Dental Health Claims, Coordination of benefits (COB), and Dental Code Sets.
  • In Depth knowledge of Medicare/Medicaid regulations.
  • Understanding of Pricing and Authorizations
  • Personality that is able to speak up and give direction
  • Clear understanding of dental benefit structures.
  • Excellent written skills and oral communication skills
  • 10 key by touch

Smile Brands Inc. and all relevant Affiliates are Equal Opportunity Employers.

DISCLAIMER: Please be aware of suspicious recruiting emails and text messages scams that attempt to collect your personal information. You will never be asked for your driver license or Social Security number during an online interview. Additionally, we do not attempt to collect money, gift cards or request you to purchase equipment on behalf of the company.

Company Details

Smile Brands

Irvine, California, United States

Smile Brands Inc. is one of the largest dental service organizations in the nation. We provide comprehensive business support services to our affiliated dental groups throughout the nation, so dentists can spend more time caring for their patients and less time on administrative, marketing and financial aspects of operating a practice. At Smile Brands, culture simply isn’t a nice idea or cl...