Dental Revenue Cycle Specialist at Forge Specialty Partners LLC – Ladson, South Carolina

Job Type: Full-Time
Location: Ladson, SC

The Dental Revenue Cycle Specialist plays a critical role in protecting and optimizing the financial performance of a multi-surgeon, multi-location oral surgery practice. This position is responsible for the accurate and timely management of claims submission, payment posting, accounts receivable follow-up, and payer communication to ensure maximum reimbursement and revenue integrity.

This role requires strong attention to detail, analytical thinking, payer knowledge, and a proactive approach to resolving reimbursement barriers. The Revenue Cycle Specialist serves as a liaison between patients, providers, and insurance carriers to ensure accurate billing, regulatory compliance, and an exceptional patient financial experience.

• Review daily surgical schedules to ensure services are billed accurately and in accordance with documentation and payer requirements
• Prepare, scrub, and submit clean claims for medical and dental payers
• Ensure proper coding and claim set-up based on procedures, modifiers, and payer guidelines
• Monitor claim acceptance and resolve rejections promptly

• Accurately post insurance and patient payments
• Review and interpret Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs)
• Identify contractual discrepancies and underpayments
• Reconcile payments against fee schedules and negotiated rates

• Proactively work unpaid claims and aged accounts receivable
• Identify denial trends and root causes
• Submit timely appeals with appropriate documentation
• Follow through to resolution to ensure proper reimbursement

• Communicate with insurance carriers to resolve claim issues and obtain clarification on benefits and processing
• Respond to payer requests for additional documentation in a timely manner
• Maintain working knowledge of commercial, Medicare, Medicaid, and leased network plans
• Understand coordination of benefits, medical vs. dental billing, and payer-specific requirements

• Respond to patient inquiries regarding billing and insurance processing
• Provide clear, professional communication regarding account balances and insurance activity
• Support a positive and transparent financial experience

• Enter and maintain accurate patient insurance demographics in practice management software
• Ensure compliance with HIPAA, OSHA, and internal policies
• Maintain required accuracy standards during account audits
• Adhere to all established and newly implemented RCM procedures

• Identify workflow improvement opportunities to reduce denials and increase collection efficiency
• Collaborate with insurance verification, front office, and clinical teams to resolve billing barriers
• Maintain professionalism in all telephonic and written communication
• Support departmental goals related to Days in AR, Net Collection Rate, and Denial Rate

• Prior experience in dental or medical revenue cycle management required (oral surgery experience preferred)
• Strong understanding of EOB interpretation, claim lifecycle, and denial management
• Knowledge of dental and medical coding preferred
• Experience with multi-location or multi-provider environments a plus
• High attention to detail and ability to manage multiple priorities
• Strong communication and problem-solving skills
• Proficiency in practice management software systems

Revenue Cycle is not simply posting payments, it is the financial backbone of the organization. The work performed in this role directly impacts practice growth, provider compensation, operational stability, and the patient experience.

Expectations & Availability

• This role is on-site.
• Employees must attend meetings, trainings, and support on-site initiatives.
• Be responsive during working hours; notify supervisors of changes promptly.

Key Metrics (KPIs & SLAs)

• Claim Submission: Within 48 hours of service.
• Payment Posting: Within 3 business days.
• AR less than 90 Days: Maintain at 10% or less.
• Denial Rate: less than 5% | Rejection Rate: less than 2%
• Appeals: Submitted within 5 business days.
• Refunds: Initiated within 2 days, processed in 7–10 days.
• Patient Inquiries: Respond within 24 hours.
• Internal/External Communication: Response required within 24 hours.
• Escalations: Billing errors unresolved after 48 hours must be escalated.
• Documentation: Same-day entries with proper attachments.