A vendor is sought to provide an insurance billing solution designed for a complex academic dental environment. The required solution must be scalable, compliant, and high-performing, with the goal of improving revenue cycle outcomes, reducing aged accounts receivable balances, strengthening denial prevention and resolution, and enhancing transparency through consistent reporting and performance management.

Core responsibilities include end-to-end insurance billing and claims processing: preparing, reviewing, and submitting dental and medical insurance claims in accordance with payer requirements, resolving claim edits and errors to maximize first-pass acceptance, submitting electronic claims via approved clearinghouses, and actively monitoring claims through adjudication with timely corrective actions on rejections or denials. The vendor will also handle billing for oral surgery services, ensuring application of proper CPT, ICD-10, modifiers, and cross-coding, and supporting requirements such as prior authorization, medical necessity documentation, and payer follow-up.

Additionally, the provider will post insurance payments from agency files or manually as needed, retrieve and reconcile Explanation of Benefits when payments are received, and identify and resolve underpayments, overpayments, and posting discrepancies. Duties also include managing insurance refunds, payer recoupments, and resolving insurance credit balances. The contract will be for one year.