ROLE OVERVIEW

The Pre-Authorization & Billing Specialist plays a dual role in the Revenue Cycle Management (RCM) department by ensuring timely and accurate pre-authorizations for procedures and submitting clean claims for reimbursement. This role serves as a key link between clinical operations, insurance payers, and the billing team to help maximize revenue, reduce denials, and maintain compliance.

KEY RESPONSIBILITIES

Submit timely and complete pre-authorization requests to insurance payers with supporting documentation (clinical notes, X-rays, narratives). Track authorization statuses, follow up on pending requests, and escalate delays as needed. Maintain detailed logs of approval/denial statuses, including authorization numbers and expiration dates. Communicate authorization updates to clinical and front office teams in a timely manner. Stay current with payer-specific pre-auth requirements and documentation rules. Submit accurate, compliant claims using proper CDT, CPT, and ICD-10 coding. Resolve claim edits and rejections in clearinghouse or EHR system. Coordinate with insurance verification and AR teams to ensure all claim data is correct. Ensure claims are submitted within payer timely filing deadlines. Document claim actions in patient accounts for visibility and continuity. Partner with pre-authorization and AR follow-up teams to avoid billing delays. Escalate denials, trends, or payer policy updates to leadership. Maintain compliance with HIPAA, payer regulations, and company SOPs. Participate in training, audits, and process improvement initiatives as needed. Essential Qualifications Prior experience in dental office revenue cycle functions, with expertise in: Scheduling & Registration

• Understanding patient flow and eligibility verification. Insurance Verification
• Confirming coverage, benefits, and policy limitations. Fee Schedules & Charging/Coding
• Ensuring accurate claim submission using CDT, CPT, and ICD-10 codes. Claim Submission & Follow-Up
• Knowledge of clean claim processing, payer-specific requirements, and handling rejections/denials.

Strong knowledge of reimbursement & compliance processes for: Medicare, Medicaid, PPO, HMO, and Fee-for-Service (FFS) plans Payer guidelines, coordination of benefits (COB), and timely filing limits Insurance dispute resolution and appeal submission best practices Proficiency in dental billing software & industry tools: Practice Management Systems (PMS): CareStack , WinOMS , OMSVision , Dentrix, Eaglesoft, etc.

Insurance Portals & Clearinghouses:

Working with Navinet , Availity, Change Healthcare, and payer-specific platforms

Microsoft Office Suite:

Strong computer literacy. Strong interpersonal and organizational skills to work effectively within a team and independently. Excellent oral and written communication skills, particularly in handling payer escalations and patient billing inquiries. Demonstrates attention to detail, accuracy, and analytical thinking in identifying claim discrepancies. Accountable for quality work, meeting deadlines, and adhering to RCM compliance and SOPs.

What We Offer:

Core Benefits & Wellness Comprehensive Medical, Dental & Vision Insurance (Virtual Care included) Confidential Employee Assistance Program (EAP) for you and your family Financial Wellness Competitive Pay with Bonus Opportunities & Annual Merit Increases 401(k) Retirement Plan with Company Match Health Savings Account (HSA) options with HDHP plans Life Insurance Protection Company-Paid Basic Life Insurance Optional Supplemental Life Coverage for You, Your Spouse & Children Time Away & Life Balance Generous Paid Vacation (starting at 2 weeks!) + 6 Paid Holidays Short

• and Long-Term Disability Coverage Supportive Leave of Absence Options