Job Description
Job Description
Job Title : Revenue Cycle Specialist (Ortho Focused)
Department : Revenue Cycle Management
Reports To : Revenue Cycle Manager
Location : HQ
Job Type : Full Time
Position Summary :
We are seeking a detail-oriented and experienced Revenue Cycle Specialist (Ortho Focused) to join our team. The ideal candidate will be responsible for managing the orthodontic revenue cycle—from insurance verification and claims submission to patient collections, and insurance payment reconciliation. This role plays a critical part in ensuring accurate and timely reimbursement for orthodontic services, while providing exceptional support to patients and staff. While this position has primary ownership over orthodontic revenue cycle responsibilities, candidate will be cross-trained in all areas of dentistry to provide support for all areas of the organization when needed.
Key Responsibilities :
- Insurance Verification & Authorization :
Verify patient insurance coverage and orthodontic benefits prior to treatment.
Obtain pre-authorizations and submit necessary documentation to insurance carriers.Communicate benefit details clearly with internal teams.Claims Management :Prepare and submit accurate orthodontic insurance claims (electronic and paper).
Follow up on outstanding claims, denials, and underpayments.Work directly with insurance companies to resolve claim issues in a timely manner.Post all electronic and check insurance payments.Patient Billing & Collections :Initiate semimonthly automatic patient payment processing and follow up on all denials.
Collect and post patient payments received at headquarters.Monitor accounts receivable and follow up on overdue balances.Compliance & Documentation :Maintain up-to-date knowledge of insurance regulations along with dental and orthodontic billing codes (ADA codes).
Ensure proper documentation and patient records are maintained for audit readiness.Adhere to HIPAA and all relevant compliance policies and procedures.Reporting & Analytics :Generate and analyze revenue cycle reports related to orthodontic services.
Identify trends and recommend process improvements to enhance financial performance.Qualifications :
High school diploma or equivalent; associate’s or bachelor’s degree in healthcare administration, business, or related field preferred.2+ years of experience in dental / orthodontic billing, insurance, or revenue cycle management.Strong knowledge of dental / orthodontic billing codes, claim processes, and insurance guidelines.Experience with dental practice management software (Ortho2 & Dentrix Ascend).Excellent communication, problem-solving, and organizational skills.High attention to detail and accuracy in data entry and financial calculations.Ability to work independently and as part of a collaborative team.Preferred Qualifications :
Experience working in a multi-location dental or orthodontic practice.Familiarity with orthodontic-specific financial workflows (monthly contracts, phase payments, etc.).Benefits :
Competitive compensationHealth, dental, and vision insurance401(k) with company matchPaid time off and holidaysOpportunities for growth and advancement