insurance coder/coordinator ORIS DENTAL CENTER

1. Accurate Coding of Dental Procedures and Diagnoses

• Code dental services: Apply the correct codes for a variety of dental services, including preventive care (e.g., cleanings, checkups), restorative treatments (e.g., fillings, crowns), surgical procedures (e.g., extractions, root canals), and orthodontic treatments.
• Utilize dental-specific coding systems: Dental coders work primarily with the CDT (Current Dental Terminology) codes, which are issued by the American Dental Association (ADA). They may also use ICD-10-CM codes for diagnoses and conditions related to the dental treatments.
• Assign accurate procedure and diagnostic codes: Ensure procedures, diagnoses, and any complications or anomalies are accurately captured using CDT and ICD-10 codes to avoid errors and claim denials.

2. Claims Processing and Submission

• Prepare and submit claims: Code and submit dental insurance claims to insurance companies, ensuring that all relevant codes are included and that the claim is complete and accurate.
• Verify patient information: Check patient information, including eligibility and benefits, to ensure that all data provided is correct before submitting claims.
• Monitor claim status: Track submitted claims, ensuring that they are processed efficiently and payments are received.
• Address claim denials: Investigate and resolve denied claims by appealing decisions, correcting coding errors, and resubmitting claims where necessary.

3. Ensuring Compliance with Regulations

• Stay current on coding updates: Dental coders must stay up to date with any changes or updates to the CDT codes and ICD-10 codes and be aware of specific payer guidelines and requirements.
• Adhere to industry standards: Follow insurance industry standards, including compliance with regulations like HIPAA (Health Insurance Portability and Accountability Act) for patient data protection and ADA standards for dental billing.
• Verify compliance with payer-specific policies: Different insurance companies may have specific requirements or restrictions on what procedures they will cover, so dental coders need to ensure that each claim adheres to these policies.

4. Reviewing and Interpreting Patient Records

• Examine patient charts: Review detailed patient records, including diagnostic information, treatment notes, and any additional information provided by dental professionals, to ensure correct coding.
• Clarify discrepancies: If there are unclear details or missing information, the dental coder must collaborate with the dentist, dental office staff, or insurance representatives to resolve any discrepancies before submitting claims.

5. Communicating with Dental Providers and Insurance Companies

• Coordinate with dentists: Work closely with dentists, hygienists, and other dental care providers to ensure that treatment plans are accurately documented and that the proper codes are applied.
• Interact with insurance companies: Communicate with insurance adjusters and representatives to clarify questions regarding claims, codes, coverage, and reimbursement.

6. Recordkeeping and Documentation

• Maintain organized records: Keep detailed and accurate records of all coded claims, communications, and patient documentation for auditing and future reference.
• Generate billing reports: Prepare and submit periodic reports to the dental office or practice management to ensure that billing is up to date and accurate.
• Audit dental claims: Conduct regular audits of submitted claims and coding accuracy to ensure compliance with insurance rules and prevent errors.

7. Handling Reimbursements and Payments

• Track reimbursements: Monitor the payment process to ensure that claims are reimbursed in full and on time. Identify underpayments or discrepancies and address them as needed.
• Assist with patient billing: In some cases, dental coders may assist patients with understanding their billing statements, explaining charges, and determining what their insurance will cover.

8. Education and Training

• Keep up with training: Dental coders must engage in continuous learning to stay updated on changes in dental coding practices, insurance guidelines, and new CDT codes.
• Assist with staff training: If part of a larger dental practice or clinic, a dental coder may be responsible for helping train other administrative or clinical staff on proper coding procedures.

Key Skills and Qualifications for Dental Coders:

• Knowledge of Dental Terminology and Procedures: A strong understanding of dental treatments and terminology is essential for accurately coding dental procedures.
• Expertise in CDT Codes: Familiarity with the Current Dental Terminology (CDT) codes, as well as the ICD-10-CM codes for dental diagnoses.
• Attention to Detail: Accuracy is crucial in dental coding to ensure proper billing and to prevent denials or fraud.
• Communication Skills: Ability to communicate clearly with dental providers, patients, and insurance companies.
• Analytical Skills: Ability to analyze patient records and determine the appropriate codes for treatments, procedures, and diagnoses.
• Computer Skills: Proficiency in using dental billing software, coding tools, and other healthcare management systems.
• Knowledge of Insurance Policies: Understanding of different dental insurance plans, including Medicaid, private insurance, PPOs, and HMO networks, and how to properly bill each.