RCM Specialist - Insurance AR (Dental)

Position Summary:

The RCM Specialist – Insurance AR is responsible for managing assigned dental insurance accounts receivable from follow-up through appropriate final resolution. This role will research and resolve outstanding and underpaid claims, denials, corrected claims, appeals, requests for additional information, and other barriers to reimbursement while supporting timely and accurate movement of insurance AR.

This position requires strong dental insurance AR knowledge, independent problem-solving, sound judgment, and the ability to move claims toward resolution rather than simply completing follow-up activity. The RCM Specialist – Insurance AR will also identify and report recurring denial, reimbursement, payer, and process trends that contribute to preventable AR and rework.

The role is part of the broader Revenue Cycle Management function and may support additional RCM responsibilities and special projects based on organizational priorities and business needs.

Essential Duties & Responsibilities:

• Manage assigned dental insurance AR from follow-up through appropriate final resolution.
• Research and resolve outstanding, unpaid, and underpaid dental insurance claims using payer portals, clearinghouse tools, practice management system information, EOBs/ERAs, payer communication, and available internal documentation.
• Review and resolve claim denials, rejections, corrected claims, reconsiderations, appeals, requests for additional information, and other reimbursement barriers.
• Independently determine appropriate next steps and drive claims toward resolution, escalating only when additional authority or cross-functional intervention is required.
• Prioritize assigned AR based on aging, financial impact, timely filing and appeal requirements, payer response, and established RCM priorities.
• Monitor assigned claims to ensure timely follow-up and prevent avoidable gaps in collection activity.
• Protect timely filing, reconsideration, and appeal deadlines for claims under assigned ownership.
• Review EOBs/ERAs and payer responses to validate adjudication, reimbursement, contractual adjustments, denials, and remaining balances.
• Identify potential underpayments, inappropriate denials, reimbursement discrepancies, and other opportunities for appropriate revenue recovery.
• Maintain complete and accurate documentation of claim status, payer communication, actions taken, supporting information, next steps, and follow-up requirements.
• Identify, track, and report recurring denial, reimbursement, and claim-processing trends, including payer-specific patterns and upstream issues contributing to preventable AR.
• Proactively escalate trends and potential root causes and provide actionable feedback to support corrective action and reduce recurring rework.
• Partner cross-functionally with RCM, Operations, Payer Relations, Credentialing, clinical teams, and other internal partners when additional information or intervention is necessary to resolve assigned AR.
• Participate in process improvement efforts designed to improve claim resolution, reduce aging AR, and prevent recurring reimbursement issues.
• Support additional Revenue Cycle Management functions and special projects as needed based on organizational priorities and business needs.

Qualifications:

• Demonstrated experience working dental insurance accounts receivable required.
• Experience with dental claim follow-up, denial resolution, corrected claims, reconsiderations, appeals, underpayments, and aging AR required.
• Strong working knowledge of dental insurance reimbursement, payer requirements, claim adjudication, common denial reasons, timely filing requirements, and dental insurance terminology.
• Experience interpreting dental EOBs/ERAs, payer responses, contractual adjustments, and reimbursement discrepancies.
• Denticon experience strongly preferred. Candidates with significant dental insurance AR expertise and demonstrated ability to quickly learn complex practice management systems will also be considered.
• Ability to independently research unfamiliar claim and reimbursement issues, determine appropriate action, and drive claims through resolution with minimal oversight.
• Ability to recognize patterns and distinguish individual claim issues from recurring payer, process, configuration, or upstream problems.
• Strong attention to detail and ability to manage a high-volume workload while maintaining accuracy.
• Strong organizational, prioritization, and documentation skills.
• Strong Excel skills, including the ability to organize, filter, reconcile, and analyze AR and reimbursement data.
• Ability to communicate trends, barriers, and recommended actions clearly and effectively.
• Ability to collaborate effectively across RCM, Operations, Payer Relations, Credentialing, clinical teams, and other functional areas.
• Ability to work independently and effectively in a remote environment.

Key Success Measures:

• Resolution rate of assigned insurance AR, with emphasis on claims brought to appropriate final disposition rather than claims merely worked or touched.
• Effective movement and reduction of assigned aging AR across established aging categories.
• Timely follow-up of assigned claims with minimal avoidable gaps in collection activity.
• Successful resolution of denials, corrected claims, reconsiderations, appeals, underpayments, and other reimbursement barriers.
• Protection of timely filing, reconsideration, and appeal deadlines for claims under assigned ownership.
• Appropriate identification and recovery of underpayments and other collectible insurance balances.
• Reduction in preventable write-offs through thorough research and appropriate collection activity before final disposition.
• Complete and accurate documentation of claim status, actions taken, payer responses, next steps, and follow-up requirements.
• Timely identification and reporting of recurring denial trends, payer patterns, root causes, and upstream issues contributing to preventable AR.
• Actionable feedback and effective escalation of systemic issues that can reduce recurring denials, rework, and future AR.
• Consistent contribution to broader RCM priorities and special projects as business needs require.