RCM Operations Specialist

We are looking for a highly analytical and detail-oriented RCM Operations Specialist with extensive knowledge of the dental industry and revenue cycle management to join our team. In this role, you will be responsible for identifying and resolving fee schedule and plan discrepancies, optimizing insurance verification processes, and ensuring efficient revenue cycle operations. Your expertise will directly impact the financial health of our practices by improving accuracy and efficiency in fee schedule management. 

This is a remote position with opportunities to collaborate across multiple departments to drive process improvements. 

Core Competencies: 

Industry Expertise: Deep understanding of dental insurance verification process, fee schedules set-up, insurance dental plans and trends. 

Analytical Skills: Strong ability to interpret insurance verification data, fee schedules, and credentialing information to identify and resolve discrepancies. 

Technical Proficiency: Intermediate proficiency in Microsoft Office Suite (Excel, PowerPoint, Visio); experience with DentalXChange and Denticon is preferred. 

Job Expectations: 

Troubleshoot Insurance verification & Fee Schedule Issues: Identify and resolve insurance verification errors, fee schedule discrepancies, fee schedule adjustments, insurance verification issues, contact payors to obtain fee schedules, fee schedule and plan set up with Denticon and review claim rejections using DentalXChange. 

Collaborate with Internal Teams: Work closely with dental offices, RCM teams, and other DCA departments to provide guidance on insurance verification, fee schedule assignments, and plan setup, ensuring compliance with industry standards. 

Vendor Liaison: Act as the primary point of contact between dental offices and insurance vendors, ensuring timely issue resolution and process standardization. 

Analyze Billing & Payment Data: Monitor billing trends, identify recurring fee schedule errors, and provide strategic recommendations for process improvements. 

Documentation & Reporting: Maintain detailed records of fee schedules, plans, and carrier payment issues, track issue resolutions, and generate reports on key findings and trends for senior management. 

Training & Support: Conduct training sessions for dental office staff on fee schedules, insurance verification processes, and best practices to minimize recurring issues. 

Stay Updated on Industry Changes: Continuously monitor industry standards and payer policy updates to ensure compliance and operational optimization. 

Education: Experience in a dental-related field preferred. 

Experience: Minimum of 7 years of experience in Dental Revenue Cycle Management (RCM) or the dental industry. 

Knowledge: Strong understanding of insurance verification, fee schedule management, claims processing, and payer reimbursement policies.