How to Be Dental Reimbursement Specialist - Job Description, Skills, and Interview Questions

Apr 5, 2021 / 5 Minutes Read / By Albert

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The lack of a Dental Reimbursement Specialist can have a detrimental effect on a dental practice. Without the specialist, it can be difficult to effectively manage claims and reimbursement from insurance companies, leading to financial strain. Furthermore, it can be difficult to keep up with the ever-changing regulations and policies that often apply to dental reimbursement.

the specialist is crucial in communicating with patients regarding their dental coverage and how that affects their treatment. Without the specialist, it can be hard for the patient to understand their benefits and how they will be covered for certain procedures. These issues can lead to reduced patient satisfaction and potentially lower profits for the practice.

Steps How to Become

Earn a High School Diploma or GED. Most Dental Reimbursement Specialists need at least a high school diploma or GED to obtain entry-level positions.
Complete a Postsecondary Program. Dental Reimbursement Specialists typically need to complete a postsecondary program in dental billing, medical coding, or health information technology. These programs are available at community colleges and technical schools.
Obtain Certification. Many employers prefer to hire Dental Reimbursement Specialists who have obtained certification from an accredited organization, such as the American Academy of Professional Coders (AAPC).
Get a Job. It is important to have experience in the field when applying for positions as a Dental Reimbursement Specialist. Consider applying for internships or entry-level positions at a dental office or insurance company.
Gain Experience. As a Dental Reimbursement Specialist, it is important to stay up to date on insurance policies, coding systems, and software applications. Consider taking additional courses or attending seminars to stay current in the field.

Staying ahead and efficient as a Dental Reimbursement Specialist requires careful planning, organization and time management. Effective time management strategies help to prioritize tasks and reduce stress. Ensuring accurate records of patient information and all reimbursements are critical, as well as regular communication with patients, insurance companies and dental offices.

Having a good understanding of industry protocols and regulations is also essential in order to ensure timely payments and maintain a good reputation. Without proper planning and organization, the specialist may find themselves overwhelmed by deadlines, leading to delays in reimbursements. This can have a negative impact on patient satisfaction and finances, as well as the reputation of the organization.

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Job Description

Process and review dental claims for accuracy and completeness.
Identify and resolve discrepancies related to dental claims.
Maintain and update dental reimbursement databases.
Respond to inquiries from internal and external customers regarding dental reimbursement issues.
Prepare and submit documents for payment of claims in accordance with applicable regulations.
Analyze and interpret dental insurance policies to ensure accurate reimbursement of claims.
Monitor and review dental claim processing to ensure accuracy and timeliness of payment.
Develop and implement dental reimbursement programs to increase efficiency.
Generate reports to assess the effectiveness of reimbursement programs.
Provide training to staff on dental reimbursement policies and procedures.

Skills and Competencies to Have

Knowledge of relevant legal regulations and standards for dental reimbursement
Proficiency in dental coding and billing
Strong analytical and problem-solving skills
Proficiency in MS Office applications and other computer programs used for dental reimbursement
Excellent customer service skills
Ability to manage multiple projects simultaneously
Ability to work independently and in a team environment
Ability to interpret and explain complex information to patients and providers
Ability to interpret and explain insurance coverage and reimbursement policies
Ability to analyze data and identify trends and patterns related to dental reimbursements

Being a Dental Reimbursement Specialist requires a variety of skills to ensure accurate and timely payment for dental services. The ability to maintain meticulous records and stay organized is paramount for success in this role. Being an effective communicator, both orally and in writing, is also essential, as this role may involve interacting with healthcare providers, insurance carriers, and patients.

The ability to interpret policy language and identify coding discrepancies is critical to ensure accurate payment. having a strong understanding of insurance plans and regulations as well as the ability to multi-task effectively are necessary for this role. As a result, Dental Reimbursement Specialists must possess a combination of administrative, financial, and customer service skills in order to be successful.

Dental Office Receptionist, Dental Benefits Verification Specialist, and Orthodontic Assistant are related jobs you may like.

Frequent Interview Questions

What experience do you have with dental reimbursement processes?
What are your biggest strengths and weaknesses with regards to dental reimbursement?
How do you stay current on changes in health care reimbursement policies?
Describe your experience in researching and resolving reimbursement issues?
Describe how you would handle a difficult situation with an insurance provider regarding a reimbursement?
What methods or systems do you use to ensure accuracy when processing dental reimbursement claims?
Explain how you would develop relationships with insurance providers to facilitate better reimbursement rates?
How do you ensure that claims are paid in a timely manner?
How do you stay organized when managing multiple claims?
Describe any customer service experience you have that would be beneficial for working with insurance providers?

Common Tools in Industry

Electronic Health Records System. A software system that securely stores patient health information and is used to track patient medical history. (e. g. Epic)
Claim Processing Software. Software used to review and process dental claims quickly and accurately. (e. g. DentalClaimsPlus)
Accounting Software. Software used to manage financial transactions and accounts payable/receivable. (e. g. QuickBooks)
Document Scanner. A device used to scan and store patient documents electronically. (e. g. Fujitsu ScanSnap)
Deduction Analysis Software. Software used to identify discrepancies in deductions from dental insurance companies. (e. g. ClaimAudit)
Customer Relationship Management Software. Software used to manage customer relationships, record customer data, and track customer interactions. (e. g. Salesforce)
Communication Platform. A service that allows for secure online communication between patients and dental staff. (e. g. Doxy. me)
Insurance Verification Tool. A tool used to verify patient insurance eligibility and coverage details prior to submitting a claim. (e. g. Availity)

Professional Organizations to Know

American Dental Association (ADA)
Academy of General Dentistry (AGD)
National Association of Dental Plans (NADP)
National Association of Dental Laboratories (NADL)
National Association of Disability Insurance Providers (NADIP)
American Academy of Dental Practice Administration (AADPA)
American College of Dentists (ACD)
American Dental Education Association (ADEA)
American Association of Dental Examiners (AADE)
Association of Dental Support Organizations (ADSO)

We also have Orthodontic Treatment Coordinator, Orthodontics Billing and Coding Specialist, and Orthodontic Hygienist jobs reports.

Common Important Terms

Credentialing. The process of verifying that a healthcare provider meets the qualifications to provide services covered by a health insurance plan.
Fee Schedule. A list of charges set by a health insurance plan for specific services.
Co-payment. An amount paid by the patient at the time of service, typically in addition to the insurance reimbursement.
Usual, Customary and Reasonable (UCR) Fees. A fee the insurance company determines is fair for a given service based on a survey of providers in the area.
Pre-authorization/Pre-determination. The process through which a health insurer decides whether to cover a particular service prior to providing payment.
Claims Submission. The process of submitting claims for reimbursement to a health insurance plan.
Denial of Claim. When an insurance company refuses to cover a service that has been requested.
Appeals. The process of requesting a review of a denied claim by an insurance company.
Explanation of Benefits (EOB). A document sent to a patient that explains what services were provided, how much was paid, and how any remaining balance is to be paid.
Reimbursement. The amount of money that a health insurance plan pays for a service after all deductibles and co-payments have been made.

Frequently Asked Questions

What is a Dental Reimbursement Specialist?

A Dental Reimbursement Specialist is responsible for managing insurance claims and filing appeals for dental practices to ensure that they receive maximum reimbursement for services provided.

What skills are necessary to be a successful Dental Reimbursement Specialist?

Successful Dental Reimbursement Specialists have strong organizational skills, attention to detail, knowledge of dental coding, and excellent customer service skills.

What type of experience do Dental Reimbursement Specialists need?

Dental Reimbursement Specialists typically need at least two years of experience in a dental office and a certification from the National Association of Dental Plans (NADP).

What is the primary duty of a Dental Reimbursement Specialist?

The primary duty of a Dental Reimbursement Specialist is to ensure that dental practices receive accurate and timely reimbursement for services provided by filing insurance claims and appealing denied claims.