Medical Billing AR Specialist

Position Summary:

The Medical Billing & AR Specialist is responsible for managing medical billing activities related to dental procedures, including medical claim submission, pre-authorizations, claim follow-up, denial resolution, and appeals. This role will also support dental insurance accounts receivable follow-up and other Revenue Cycle Management functions based on organizational priorities and business needs.

This position requires strong knowledge of dental-to-medical billing and the ability to independently manage claims from initial submission through final resolution. The Medical Billing & AR Specialist will identify and report recurring denial and reimbursement trends, determine root causes, and provide actionable feedback to improve first-pass payment and reduce preventable rework.

The role will also support the development and maintenance of documented internal medical billing workflows to promote operational continuity, cross-training, and consistent execution.

Essential Duties & Responsibilities:

Prepare and submit medical claims for eligible dental and oral procedures, ensuring accurate coding, required documentation, and payer-specific requirements are met.

Manage medical pre-authorizations from initial submission through determination, including obtaining necessary clinical documentation, responding to requests for additional information, and performing timely follow-up.

Perform follow-up on outstanding medical claims through final resolution, including payer outreach, corrected claims, reconsiderations, denials, appeals, and additional documentation requests.

Review rejected and denied claims to determine root cause and take appropriate corrective action.

Identify, track, and report recurring denial and reimbursement trends, including payer-specific patterns, documentation deficiencies, authorization issues, coding concerns, and other barriers to first-pass payment.

Proactively escalate identified trends and recommend corrective actions designed to prevent recurrence and improve reimbursement outcomes.

Work assigned dental insurance AR, including outstanding claims, denials, appeals, corrected claims, and other follow-up activities as organizational priorities and capacity require.

Prioritize assigned AR based on aging, financial impact, timely filing requirements, payer response, and other established RCM standards.

Maintain complete and accurate documentation of claim status, payer communication, actions taken, supporting documentation, and required next steps.

Monitor claims through adjudication and ensure appropriate reimbursement or final disposition.

Partner with clinical, operational, RCM, and other internal teams to obtain information necessary for claim submission, authorization, appeal, and resolution.

Maintain accurate, current documentation of medical billing, pre-authorization, and follow-up workflows to support operational continuity, cross-training, and consistent execution.

Participate in the development and improvement of processes designed to increase clean claim performance, first-pass payment, and overall AR resolution.

Support additional Revenue Cycle Management functions and special projects as needed based on organizational priorities and business needs.

Qualifications:

• Demonstrated experience with medical billing for dental and/or oral procedures required.
• Experience with medical claim submission, medical pre-authorizations, claim follow-up, denials, appeals, and reimbursement resolution.
• Demonstrated experience working dental insurance accounts receivable required, including claim follow-up, denial resolution, corrected claims, appeals, and aging AR.
• Strong understanding of medical and dental insurance reimbursement processes and payer requirements.
• Experience interpreting EOBs/ERAs, payer responses, denial reasons, authorization requirements, and supporting clinical documentation.
• Denticon experience strongly preferred. Candidates with significant dental-to-medical billing expertise and demonstrated ability to quickly learn complex practice management systems will also be considered.
• Familiarity with medical claim forms, coding requirements, and documentation standards applicable to dental procedures billed to medical insurance.
• Ability to independently research claim and reimbursement issues, determine root cause, and drive claims through resolution with minimal oversight.
• Strong attention to detail and ability to manage a high-volume workload while maintaining accuracy.
• Strong organizational, prioritization, and documentation skills.
• Strong Excel skills, including the ability to organize, filter, reconcile, and analyze claim and reimbursement data.
• Ability to identify patterns and translate claim-level findings into actionable trends and recommendations.
• Ability to collaborate effectively across RCM, clinical, operational, and other functional teams.
• Ability to work independently and effectively in a remote environment.
• Key Success Measures: First-pass paid rate, with focus on increasing the percentage of claims paid without correction, resubmission, appeal, or additional intervention.
• Clean claim rate and reduction in preventable front-end claim rejections.
• Timely and accurate submission of medical claims and pre-authorizations.
• Timely follow-up and resolution of assigned medical and dental insurance AR.
• Reduction in preventable denials and recurring reimbursement issues.
• Effective movement and resolution of assigned aging AR, including 30-, 60-, 90-, and 90+ day balances.
• Successful resolution of denied claims, corrected claims, reconsiderations, and appeals.
• Timely identification and reporting of denial trends, root causes, payer patterns, and actionable opportunities to improve first-pass payment and reduce preventable rework.
• Complete and accurate claim documentation, including actions taken, payer responses, and next steps.
• Development and maintenance of current medical billing, pre-authorization, and follow-up workflow documentation to support operational continuity and cross-training.

Pay Range: $26/HR - $28/HR

Step into a new era with PCDM

A modern practice environment designed for superior care and comfort.

We embrace cutting-edge technology in a soothing environment that goes beyond your ordinary dental practice. We’ve thought through every step in the patient’s experience to perfect our communication and care so that each visit is an eagerly anticipated event.

We’re a team that supports your success.

Emphasizing health over sales, we cultivate a warm, supportive culture without the pressure of production quotas. Those motivated for growth in their career are encouraged and supported to reach their full potential.

We celebrate diversity.

Our company 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 in terms of all conditions of employment. Our diversity is one of our greatest strengths, and as an Equal Opportunity Employer, we are proud to promote a work environment where all differences are respected.