Job Description

The primary purpose and function of the Fee Schedule Administrator is to organize and maintain all insurance fee schedules, ensuring they are loaded into the Practice Management System in a timely manner. The Fee Schedule Administrator is responsible for maintaining insurance alerts, addressing limitations and exclusions for proper billing. The Fee Schedule Administrator must understand the impact fees and alerts entered into the system have on operations and other departments within the Support Office.

Essential Duties and Responsibilities

• Ensure that company-wide insurance receivables are maximized through proper fee schedule interpretation.
• Identify and load insurance fee schedule limitations and exclusions in the Practice Management System for proper billing purposes.
• Maintain all accepted insurances plans, archive old, discontinued or unused insurance plans.
• Accurately load and maintain all fee schedules and plan alerts in the Practice Management System, ensuring fees are current and active for relevant effective dates. Distribute all insurance plan and fee schedule updates to the dental offices in a timely manner. Archive deactivated fee schedules. Coast Dental strives for 100% accuracy, but 98% is the minimum standard accepted.
• Ensure fees are being paid at the negotiated rate.
• Provide support to dental practices, responding to office inquiries regarding fees, insurance filing and portal access.
• Create and maintain all insurance CDT procedures, explosion, and product codes in our Practice Management System. Create promotional codes, as requested by the Senior Leadership Team.
• Work closely with the practices in protecting the assets of Coast Dental by properly training the offices when errors are made and how to correct them. Work to eliminate linkage errors through education and training.
• Utilize various communication methods, both on and offline, to contact insurance carriers regarding portal access issues and portal functionality issues.
• Reset passwords and manage user accounts for insurance carrier websites per office requests.
• Read and analyze explanation of benefits and make proper adjustments according to Coast Dental processing criteria.
• Perform other duties, as assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Knowledge, Skills and Abilities

• Ability to organize large amounts of data including plan documents, directories, spreadsheets, and files.
• Proficient in Microsoft Office, with an emphasis on MS Excel and the ability to use formulas such as lookups, conditional statements, and data modeling.
• Demonstrates attention to detail, multi-task, ability to handle sensitive information and main strict confidentiality.
• Oral Communication- Listens and gets clarification; Responds well to questions. Maintains constant and open communication with all parties involved in each issue.
• Written Communication- Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Able to read and interpret written information.
• Problem Solving- Identifies problems in a timely manner; Gathers and analyzes information skillfully.
• Teamwork- Balances team and individual responsibility; Contributes to building a positive team spirit.
• Professionalism- Accepts responsibility for own actions; Follows through on commitments.

Qualifications (Experience, Education, Licensure, Certification)

• Detailed experience with insurance company pricing, underwriting or medical/dental billing and coding.
• Dental office or dental experience is preferred.

Working Conditions

The Fee Schedule Administrator will work in areas that are highly visible and designed and furnished to make a good impression. Most workstations are clean, well-lighted, and relatively quiet. Work is primarily sedentary in nature.

Limitations and Disclaimer

The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.