How to Be Dental Claims Processor - Job Description, Skills, and Interview Questions

Dental claims processing is a complex process which can have a significant effect on patient satisfaction and the financial health of a dental practice. It involves verifying patient information, checking eligibility, submitting claims to insurance carriers, tracking payments, and resolving any discrepancies that arise. Improperly processed claims can lead to delayed payments, reimbursement issues, and increased administrative costs.

As a result, having an experienced and knowledgeable dental claims processor on staff is essential for an efficient and successful dental practice. The processor must be familiar with the various insurance carriers' policies, regulations, and procedures, as well as the patient's treatment plan and the practice's billing system. With the right personnel in place, processing dental claims can be a smooth and efficient process that promotes patient satisfaction and a healthy financial standing for the practice.

Steps How to Become

1. Earn a High School Diploma or GED. Most employers require a high school diploma or GED when hiring dental claims processors.
2. Take College Courses. Taking courses in medical terminology, business and accounting can help individuals prepare for a career in dental claims processing.
3. Consider Working in the Field. Many employers prefer to hire individuals with experience in the field of dental claims processing. Working as an assistant in a dental office or as a customer service representative in a health insurance office can provide valuable experience.
4. Obtain Certification. The American Academy of Professional Coders (AAPC) offers a Certified Professional Coder (CPC) certification for those interested in working in the field of dental claims processing.
5. Obtain Licensure. Most states require dental claims processors to be licensed by the Department of Insurance. This can involve taking an exam and submitting an application.
6. Maintain Certification. To maintain certification, individuals must complete continuing education courses and pass an annual recertification exam.

A reliable and capable dental claims processor is essential in order to ensure that dental practices maintain a steady cash flow and remain profitable. Without a reliable and capable processor, claims can take longer to process, resulting in delays in reimbursement which can cause financial hardship for the practice. if the processor is not sufficiently experienced and knowledgeable, they may not be able to identify any errors or omissions in the submitted claims, leading to incorrect reimbursements or even denials of claims.

This can adversely impact the practice's bottom line and cause further financial difficulty. Therefore, it is essential for dental practices to ensure that they employ a reliable and capable dental claims processor to ensure their practice remains financially secure.

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Job Description

1. Verify and process dental insurance claims for accuracy and completeness.
2. Analyze claims for accuracy of coding and benefits, and enter information into computer systems.
3. Resolve discrepancies between insurance company and provider.
4. Research and respond to inquiries from providers, members, and insurance companies.
5. Interpret and explain insurance coverage, eligibility, and benefits to providers, members, and insurance companies.
6. Enter data into various systems to maintain provider directories, fee schedules, and other records related to dental claims processing.
7. Prepare reports on denied or rejected claims for further review.
8. Respond to claim inquiries in a timely manner and provide quality customer service.
9. Maintain current knowledge of relevant health care laws, regulations, guidelines, and best practices.
10. Perform other duties as assigned.

Skills and Competencies to Have

1. Knowledge of dental coding and billing principles.
2. Ability to read and interpret dental insurance carriers’ Explanation of Benefits (EOB) forms.
3. Knowledge of electronic claims submission and the use of software applications for processing claims.
4. Ability to troubleshoot errors and inconsistencies in claims submissions.
5. Ability to accurately enter claim data into a computerized database.
6. Detail-oriented with strong organizational and time management skills.
7. Excellent customer service skills.
8. Ability to work independently and as part of a team.
9. Proficiency in Microsoft Word, Excel and Outlook.
10. Knowledge of HIPAA regulations and other applicable laws.

Having great organizational skills is essential for a Dental Claims Processor. As a Dental Claims Processor, one must be able to manage and organize numerous claims, which can be very complex. Being organized is critical in order to accurately process claims and ensure that all documents are in order.

the ability to communicate effectively with customers and insurance companies is key. Good communication skills enable a Dental Claims Processor to quickly and accurately explain the details of a claim to a customer or insurance company and understand the customer’s needs so that the claim is properly handled. Furthermore, strong computer skills are essential for a successful Dental Claims Processor because much of the work requires the use of a computer and software programs to accurately record information and process payments.

Without these skills, it would be difficult to accurately and efficiently keep up with the high volume of paperwork and customer service requests associated with this profession.

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Frequent Interview Questions

• What experience do you have processing dental claims?
• How do you stay up to date on dental billing and coding regulations?
• Describe the process you use to verify insurance coverage for dental claims.
• What challenges have you faced when processing dental claims?
• How do you ensure accuracy when entering data into the dental claims system?
• How do you handle difficult or challenging customer inquiries?
• Describe a time when you had to effectively manage multiple tasks related to processing dental claims.
• What techniques do you use to improve efficiency when processing dental claims?
• How do you maintain confidentiality of patient information when processing dental claims?
• What would you do if a claim was denied due to an error in submission?

Common Tools in Industry

1. Electronic Medical Records (EMR) Software. This software is used to store, track, and manage medical records, such as patient information and health history. (Example: Practice Fusion)
2. Claims Processing Software. This software is designed to help streamline the claims processing process and speed up the time required for reimbursement. (Example: ClaimLogic)
3. Payment Automation Software. This software automates and streamlines payment processing, allowing for faster and more secure payments and reimbursements. (Example: PayJunction)
4. Imaging Software. This software allows dental professionals to take, store, and manipulate digital images of teeth, gums, and other dental anatomy. (Example: Dentrix Image)
5. Patient Management Software. This software is designed to help manage patient information, scheduling, financials, and other aspects of the dental practice. (Example: CareCloud)

Professional Organizations to Know

1. American Dental Association
2. American Association of Dental Office Managers
3. National Association of Dental Plans
4. Academy of Dental Management Consultants
5. Dental Practice Management Association
6. American Association of Dental Practice Administrators
7. National Association of Insurance Commissioners
8. National Association of Insurance and Financial Advisors
9. American Health Information Management Association
10. Healthcare Financial Management Association

We also have Dental Records Manager, Dental Insurance Coordinator, and Dental Assistant jobs reports.

Common Important Terms

1. Third-Party Administrator (TPA). A third-party administrator is an organization that handles the processing and payment of health insurance claims for a company, usually an insurer.
2. Pre-Authorization. Pre-authorization is the process of obtaining prior approval from the insurance company for a health care service or procedure.
3. Capitation Payment. Capitation payments are a type of reimbursement that health care providers receive from insurers, in which they are paid a fixed amount on a per-member basis, regardless of the services they provide.
4. Coding. Coding is the process of assigning numerical codes to medical diagnosis and procedures.
5. Billing. Billing is the process of submitting claims to insurance companies for payment.
6. Coordination of Benefits (COB). Coordination of benefits is the process of making sure that a patient does not receive duplicate payments from different insurers or health plans for the same service.
7. Utilization Management. Utilization management is a process used by insurers to control their costs by evaluating the appropriateness and necessity of medical services.
8. Denial Management. Denial management is the process of handling denied claims, usually through appeals or re-submission of claims with additional documentation.

Frequently Asked Questions

What are the duties of a Dental Claims Processor?

The duties of a Dental Claims Processor include verifying insurance coverage, submitting claims to insurance companies, processing payment information, resolving discrepancies, and communicating with patients and other healthcare providers.

What qualifications are necessary to become a Dental Claims Processor?

To become a Dental Claims Processor, candidates must have knowledge of medical terminology and coding systems, strong communication and customer service skills, familiarity with insurance regulations, and experience in data entry and accounting.

How much does a Dental Claims Processor earn?

According to PayScale, the average salary for a Dental Claims Processor is $36,000 per year.

What software is used by Dental Claims Processors?

Dental Claims Processors typically use software systems such as Dentrix and Eaglesoft to manage patient accounts and submit claims.

What type of environment does a Dental Claims Processor work in?

Dental Claims Processors typically work in an office setting where they process claims on computers and handle customer inquiries.

What are jobs related with Dental Claims Processor?

• Dental Treatment Plan Coordinator
• Dental Care Representative
• Dental Lab Technician Supervisor
• Dental Practice Manager
• Dental Patient Advocate
• Dental Treatment Planner
• Dental Office Manager
• Dental Imaging Technologist
• Dental Supply Inventory Manager
• Dental Staff Trainer

Web Resources

• Dental Insurance Claims Process - Blackstone Career Institute blackstone.edu
• Dental Expense Plan Claim | uhr.rutgers.edu uhr.rutgers.edu
• Student Health Insurance Claims Processing University of Cincinnati www.med.uc.edu