How to Be Orthodontic Billing and Coding Specialist - Job Description, Skills, and Interview Questions

Feb 1, 2023 / 5 Minutes Read / By Albert

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The role of an Orthodontic Billing and Coding Specialist is essential for the efficient financial operations of any orthodontic practice. By accurately coding and billing for services, the specialist ensures that the orthodontic office receives timely payment for the treatments provided. In addition, the specialist can help reduce the risk of denied claims, delayed payments, and incorrect reimbursements from insurance companies.

The specialist's knowledge of coding guidelines, insurance policies, and paperwork requirements are integral to maintaining accurate records and obtaining the necessary payment for the orthodontic office. Without a qualified Orthodontic Billing and Coding Specialist, an orthodontic practice would suffer from decreased revenue, increased operating costs, and a lack of financial stability.

Steps How to Become

Obtain a high school diploma or equivalent. Most employers prefer applicants who have a high school diploma or equivalent.
Enroll in a postsecondary program. To become an orthodontic billing and coding specialist, you must complete a postsecondary program in medical billing and coding. Many schools offer programs in both medical billing and coding and orthodontic billing and coding.
Gain experience. After completing your postsecondary program, you should gain experience working in an orthodontic office or other related field. This will help you understand the process of billing and coding for orthodontic procedures.
Obtain certification. You may choose to obtain a certification in medical billing and coding, which will demonstrate your knowledge in the field and help you stand out among other job applicants.
Stay up-to-date on coding practices. As new procedures and technologies are developed in the field of orthodontics, coding practices are likely to change as well. To stay competitive, it is important to stay up-to-date on current coding practices.

To stay ahead and capable as an Orthodontic Billing and Coding Specialist, it is important to stay up to date on the latest trends and changes in the industry. This can be done by continually educating yourself on the latest coding systems, regulations, and billing processes. staying organized and being detail-oriented is important for being successful in this role.

Finally, understanding the patient's medical history and familiarizing yourself with insurance coverage policies will help you ensure that you are accurately billing and coding correctly. By staying informed and organized, orthodontic billing and coding specialists can remain ahead of the curve and capable of meeting the demands of the job.

You may want to check Orthodontic Clinical Assistant, Denturist, and Orthodontic Scheduling Coordinator for alternative.

Job Description

Collect patient records and review for accuracy of information.
Process orthodontic claims, including verifying patient eligibility and processing payments.
Monitor patient accounts to ensure appropriate billing and follow-up on unpaid claims.
Maintain accurate accounting records and review accounts receivable to identify any discrepancies.
Answer patient billing inquiries in a timely manner and provide resolution to any issues.
Utilize coding systems to accurately code orthodontic treatments and services.
Communicate with insurance companies to resolve payment issues.
Prepare and submit reports to management regarding accounts receivable.
Train staff on billing and coding procedures and policies.
Research changes in regulations and update billing practices accordingly.

Skills and Competencies to Have

Knowledge of coding systems, including ICD-10, CPT and HCPCS
Ability to handle patient records and create accurate billing statements
Proficiency in using dental software and databases
Understanding of insurance plans and reimbursement guidelines
Skill in performing financial analysis and reports
Ability to respond to billing inquiries and resolve disputes
Knowledge of orthodontic treatments, procedures, and terminology
Ability to communicate effectively with patients, providers, and staff
Attention to detail and accuracy
Good organizational skills and time management abilities

A successful Orthodontic Billing and Coding Specialist must have a wide range of knowledge and skills in order to be successful. A strong understanding of medical terminology, coding systems, and reimbursement processes is essential. Being able to accurately interpret patient records, prepare claims forms, and handle appeals are also necessities.

proficiency in customer service, math, and problem-solving are important to ensure accuracy and efficiency in all tasks. The cause-and-effect relationship is that without these important skills, an Orthodontic Billing and Coding Specialist will not be able to successfully complete their job duties. As a result, the quality of care for patients may suffer and the efficiency of the office may decline.

Orthodontic Lab Technician, Orthodontic Lab Manager, and Orthodontic Hygienist are related jobs you may like.

Frequent Interview Questions

What experience do you have in orthodontic billing and coding?
How familiar are you with the rules and regulations associated with orthodontic billing and coding?
Describe your experience with electronic medical records systems and programs related to billing and coding.
What steps do you take to ensure accuracy and completeness of patient records and billing?
How do you handle difficult conversations with patients regarding insurance coverage and billing?
Describe a time when you had to work with a difficult insurance provider.
How do you stay up to date on changes to insurance reimbursement policies?
Describe your experience working with online payment portals for patients.
How do you handle patient complaints regarding billing and coding?
What strategies do you use to maximize insurance reimbursement for orthodontic services?

Common Tools in Industry

Coding Software. A software program used to accurately assign codes to medical services and procedures. (e. g. MediSoft)
Electronic Claims Submission. Software used to electronically submit patient claims to insurance providers. (e. g. eClaims)
Billing Software. A software program used to create and manage invoices, track patient payments, and generate reports. (e. g. QuickBooks)
Practice Management System. A comprehensive system that handles all aspects of practice management, from patient records to scheduling and billing. (e. g. Open Dental)
Patient Portal. An online system that allows patients to view their records and manage appointments, payments, and more. (e. g. MyChart)
Claim Scrubbing. A software program used to identify potential errors in medical claims before they are submitted for payment. (e. g. NThrive ClaimScrubber)

Professional Organizations to Know

American Association of Orthodontists (AAO)
American Dental Association (ADA)
Academy of General Dentistry (AGD)
American College of Dental Coders and Billers (ACDCB)
National Association of Dental Plans (NADP)
Healthcare Billing and Management Association (HBMA)
American Medical Billing Association (AMBA)
American Academy of Professional Coders (AAPC)
Health Information Management Systems Society (HIMSS)
National Alliance of Medical Auditing Specialists (NAMAS)

We also have Orthodontics Practice Manager, Prosthodontist, and Orthodontic Office Assistant jobs reports.

Common Important Terms

ICD-10 Code. International Classification of Diseases, 10th Revision code which is a numerical coding system used by healthcare providers to classify diseases and disorders for billing and record keeping purposes.
CPT Code. Current Procedural Terminology code which is a numerical coding system developed and maintained by the American Medical Association (AMA) to accurately describe medical, surgical, and diagnostic procedures for use in healthcare settings for billing and record keeping purposes.
HCPCS Code. Healthcare Common Procedure Coding System code which is a numerical coding system developed and maintained by the Centers for Medicare & Medicaid Services (CMS) to accurately describe medical, surgical, and diagnostic procedures for use in healthcare settings for billing and record keeping purposes.
Fee Schedule. A list of approved fees that a healthcare provider may charge for services rendered.
Medicare. A federal health insurance program which provides healthcare coverage to individuals who are age 65 or older, certain disabled individuals, and individuals with end-stage renal disease.
Medicaid. A federal health insurance program which provides healthcare coverage to individuals who meet certain income and asset requirements.
HIPAA. The Health Insurance Portability and Accountability Act of 1996 which establishes national standards for protecting sensitive patient health information and providing patients with access to their medical records.
Claim Form. A document that is submitted to an insurance company requesting payment for services rendered.

Frequently Asked Questions

Q1: What qualifications are required to become an Orthodontic Billing and Coding Specialist? A1: Orthodontic Billing and Coding Specialists typically need to have a high school diploma or equivalent, as well as experience in medical billing, coding systems, and orthodontic terminology. Q2: What is the salary range for Orthodontic Billing and Coding Specialists? A2: The salary range for Orthodontic Billing and Coding Specialists can vary depending on their experience and the size of the organization. Generally, salaries range from $30,000 to $60,000 per year. Q3: What tasks are typically performed by Orthodontic Billing and Coding Specialists? A3: Orthodontic Billing and Coding Specialists typically help submit insurance claims, process payments, review patients' orthodontic records for accuracy, and manage data entry for patient records. Q4: What software programs are commonly used by Orthodontic Billing and Coding Specialists? A4: Orthodontic Billing and Coding Specialists typically use software programs such as Dentrix, Eaglesoft, and OrthoTrac to manage patient records and process payments. Q5: What certifications do Orthodontic Billing and Coding Specialists need? A5: Orthodontic Billing and Coding Specialists typically need to hold certifications from organizations such as the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).