A Dental Claims Processor assesses insurance claims for patients who visit the dentist’s office. The job duties include ensuring each claim is complete and the treatment received meets the criteria for the coverage as set by the insurance company. Other core duties are mentioned on the Dental Claims Processor Resume as – analyzing if the claim will be paid or not by the insurance company, reviewing the insurance policy, thoroughly determining the kind of coverage, providing necessary guidance to claimants on how to file a claim, preparing claim forms and other paperwork, escalating complicated or unusual claims to claims investigators, and performing other administrative tasks.
Those in this field often embrace the following skills and abilities – detail-oriented to understand complex paperwork, strong customer service skills, people skills, the ability to deal with frustrated and angry customers; strong logic and reasoning skills to solve a variety of coverage-related issues, and multitasking skills. While an extensive education is not a must, possessing a high school diploma is a basic requirement.
Summary : To obtain a position that utilizes my excellent customer service and communication skills. Working knowledge of the insurance industry and relevant federal and state regulations.
Skills : Front Desk, Microsoft Office, Excel, People , People, Bookkeeping, Customer Service.
Description :
Trained one on one with Dental Supervisor.
Learned Dental coding and specific services provided by dentists.
Received training in Orthodontics, Periodontal procedures and charting.
Responsible for all Training through on line CBTs and daily Ques completed.
Maintained high level of production and balance accuracy.
Responsible for correcting and Rebutting all audit errors.
Moved home to take care of terminally ill father.
Experience
7-10 Years
Level
Management
Education
Business Management
Dental Claims Processor Resume
Objective : Had experience in Office Settings as a Clerk, Processor, and Loan Officer Assistant, dealing with delinquent accounts, and credit assessing. Worked as a HR associate, processing job applications.
Skills : Food Service, Customer Service, Health Care And Retail Industries.
Description :
Communicated with insurance agents and beneficiaries.
Prepared claim forms and related documentation.
Reviewed claim submissions and verifying the information.
Recorded and maintained insurance policy and claims information in a database system.
Determined policy coverage and calculating claim amounts.
Processed claim payments.
Complied with federal, state, and company regulations and policies.
Experience
0-2 Years
Level
Entry Level
Education
Business Administration
Dental Claims Processor Resume
Objective : As a Dental Claims Processor, responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries.
Skills : Computer literate and proficient in MS Office.
Description :
Produced an average of 183 claims per day with a 99% quality rating.
Examined and processed dental claims and pre-authorizations according to member policies.
Analyzed x-rays for major services to proc less for further review by the dental consultant.
Provided updates to member family maintained records and provider records.
Promoted to Cost Recovery Specialist for strong performance and expertise in adjustments.
Processed dental claims while assigned to Guardian Insurance.
Handled all aspects of incoming mail, Ran all collated claim forms through industrial scanner.
Handled mail room duties when needed.
Received a commendation for consistently exceeding processing goals while employed at Guardian Insurance company.
Experience
0-2 Years
Level
Entry Level
Education
Associate In Business
Dental Claims Processor Resume
Summary : Organized and detail-oriented professional dedicated to improving efficiency, productivity and profitability through continuous process improvement. Analytical thinker skilled at developing innovative solutions to complex problems.
Skills : Facets System, Citrix, ClaimFacts, Macess System, Office Equipment, Word, Excel, Data Entry, Collections, Claims Processing, Auditing.
Description :
Responsible for processing dental claims and any other projects supervisor asked.
Secured incoming dental claims for principal financial group.
Analyzed each claim self-efficiently to meet quality and quantity goals.
Reviewed claims to ensure accuracy.
Participated in the processing of national and international dental claims for Blue Cross/Blue Shield customers, providing timely and accurate.
Analyzed electronically & imaged submitted claims, verifying the correct codes were used and that all procedures were accounted for on each claim.
Routed claims to Examiners or Technicians per provided guidelines so that more complex claims would be processed in a timely manner.
Created and mailed appropriate correspondence to providers and customers as necessary to process a claim.
Experience
7-10 Years
Level
Management
Education
N/A In Accounting
Dental Claims Processor Resume
Summary : Customer service professional offering thirty years of diversified experience. Excellent communication and problem- solving skills. Dedicated to achieving customer satisfaction as well as meeting or surpassing company expectations. Able to focus on projects, develop strategies and meet or exceed deadlines.
Skills : Microsoft Office Suite, Receptionist Multi Line Systems.
Description :
Examined and processed dental claims Accomplishments Expert in dental insurance policies and CDT coding Skills Used Reading dental x-rays building.
Examined and processed dental claims Built dental claims based on the insurance policy Answered customer service inquiries on dental claims.
Processed dental claims in a timely manner.
Processed dental claims, answering the telephone and helping with insurance questions.
Ran reports and match Dental Claims to Dental Providers Enter new.
Retained and updated records Maintained daily emails and reports.
Processed claims Claim reviewing Claim entry by ADA codes.
Experience
10+ Years
Level
Senior
Education
B.A.
Dental Claims Processor Resume
Headline : Self starter with strong interpersonal skills. Ethical team player with the ability to build business partnerships and trust with managers and employees to create a positive work environment for all.
Skills : Excellent critical thinking and decision-making skills.
Description :
Processed Dental Claims, independently review patient claims, entering the manual patient data form into the system Prepared account billings.
Responsible for examining and processing patient dental claims.
Handled adjustments and any discrepancies identified including billing errors.
Verified billing coding compliance in accordance with set performance and standards.
Monitored internal and external customer and member service claims questions, concerns and related issues while maintaining a superior level of .
Processed dental claims for all companies, tracking money for various groups.
Paid PDRI reviewed claims, contacting dental offices and pended reports.
Experience
5-7 Years
Level
Management
Education
High School Diploma
Dental Claims Processor Resume
Summary : Dental Claims Processor is accountable for handling customer service inquiries over the phone in a fast-paced call center environment and processing dental claims.
Skills : Good administrative and organizational skills.
Description :
Processed DHMO claims, trainer, mentor, SME, work with our Regional Network Managers, makes executive decisions regarding claims.
Worked closely with our dental consultants.
Processed our DHMO monthly capitation checks, process back charges, reverse back charges, handle DHMO Claims adjustments.
Worked with multiple systems.
Processed claims for medicaid and commercial dental insurance Companies.
Ensured accuracy and use of correct ADA codes.
Trained in new HIPPA laws.
Experience
7-10 Years
Level
Management
Education
High School Diploma
Dental Claims Processor Resume
Headline : As a Dental Claims Processor, responsible for sorting, assigning and working various reports such as building member accumulators, giving deductible credits, adjusting claims to correct various provider updates.
Skills : Strong customer service skills, Ability to work under pressure.
Description :
Processed all insurance claims using Dentrix software system Researched all insurance issues Acted as the primary liaison between patients and .
Managed a caseload of over 300 clients each quarter.
Communicated with insured individuals to explain classifications and computations.
Obtained relevant evidence and information regarding suspicious claims.
Worked in dental claims.
Processed dental claims, read xrays and contacted dentists for additional information.
Answered customers questions and concerns over the phone.
Experience
5-7 Years
Level
Executive
Education
Associate Degree
Dental Claims Processor Resume
Summary : Dental Patients Accounts Coordinator or Dental Claims Processor works closely with the Pediatric Dental physician team on the preparation of the dental treatment plans.
Skills : Strong reading, writing and verbal communication skills.
Description :
Learned the activities/tasks associated with his/her role.
Worked under direct supervision.
Relied on others for instruction, guidance, and direction.
Worked is reviewed for technical accuracy and soundness.
Coded and processed claims forms for payment ensuring all information is supplied before eligible payments are made.
Researched and analyzed claims issues.
Provided expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims.
Experience
7-10 Years
Level
Consultant
Education
Associate Degree
Dental Claims Processor Resume
Headline : As a Dental Claims Processor, responsible for obtaining and documenting authorization of medical and dental insurance before patient arrival.
Skills : Medical processing, Claims Associate, Claims support, Mental health claims.
Description :
Provided clinical interpretation and decision making, according to contractual agreements and DDWA policies, to claims prescreened by CRERs, re-evaluations, final reviews, network quality management cases, and subscriber appeals.
Responded to questions and requests (verbal and written) for information regarding clinical treatment, processing policies and payment decisions from both internal and external customers.
Participated in the Utilization Management Program; Network Quality Management workgroup; Subscriber Appeals workgroup; or Waste, Abuse, Verification and Education (WAVE) workgroup as needed.
Complied with all requirements of the Calibration Program.
Provided leadership in support of DDWA vision, mission, guiding principles and policies.
Performed on-site dental office audits when needed.
Cultivated professional and effective relationships between DDWA and the provider community through verbal and written communications, dental societies, dental schools and professional associations.
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