Managing patient claims is one of a practice's most pressing concerns. In fact, when asked in a recent survey what issues keep them up at night, dental practice leaders cited dental insurance-related issues, efforts to follow up on outstanding insurance claims in a timely manner and lack of patient understanding of the scope of their coverage.
The claims management function of a practice is obviously critical. The responsibility is challenging and can even be overwhelming since it's time-consuming, complicated and produces the life blood of a practice. That's why it's crucial to hire the right person for this type of position.
A great claims management person can help make a practice sing. This is your payer and payment person, but much more – the claims management team and its member(s) are the tip of your revenue cycle management spear.
Claims management professionals spend their days discussing claims eligibility and following up with payers. These are time-consuming tasks, so when hiring for the position, nothing should be taken lightly. While the job description is pretty straight-forward, there's so much more to the position than meets the eye.
Dental insurance claims specialists spend a large part of their days verifying eligibility – determining whether a patient's insurance policy covers certain procedures,coordinating benefits, and following up for timely claims adjudication. Claims specialists must also fully understand and be comfortable working with Current Procedural Terminology codes and International Classification of Diseases codes to review claims accurately.
If you find yourself in the position of hiring a claims management professional, there are several things that every practice leader must know about the position and those working in it to ensure the success of the practice.
1. Prepare
In preparation, you've got to understand the job description and write it down; refer to it often.
2. Reflect on your practice's needs
Reflect your needs in the publicly-posted job description. Not doing so may undermine your ability to attract the talent you need. If possible, include your staff and advisors in the hiring decision; they will be working with this new hire too.
3. Ask open-ended, appropriate questions
Ask open-ended and appropriate questions that allow you to dig deeper during the interview and receive responses other than "yes" or "no." Include obvious and not-so-obvious questions about the role and requirements of the position you're hiring. Some latitude can be given for a claims management professional without any experience if that is allowed for the position, but if you're hiring a manager or team lead you're going to have to dig in a little bit and get to the nitty gritty.
4. "Have you done this before?"
Press into the candidate's previous processing experience, asking whether the candidate prefers certain clearinghouse partners over others and why. Ask the candidate if he or she is aware of any of your technology vendor partners and about their thoughts on using electronic solutions for things like claims and attachments. If your practice is processing claims using electronic technology instead of paper and a candidate has no experience with technology, this should be a red-flag.
5. How would they handle a "stress-test"?
Be sure to ask how the candidate might deal with drop-shipped claims that are taking a long time to close out, or with an abundance of unpaid or unprocessed claims from a specific payer. The candidate's response matters. This hire will be responsible for a good deal of your practice's financial health, and there will be times when he or she will have to be equal parts bull dog and peace ambassador. You want someone who's a tough cookie when it comes to pushing payers to improve your revenue cycle. Dig into the candidate's ability to handle pressure – phones ringing with patient questions, deadlines looming, payer payments running late, technology needing to be managed and partners patrolled. All of these things are likely to happen every single day.
6. Don't forget the basics.
Outside of the job description, you've got to find a representative who is friendly, persuasive and possesses a strong attention to detail. Collaborating during chaos also is key, so make sure that they are a fit for the personality of your practice. A detail-oriented, roll-with-it claims management professional is worth more than his or her weight in proverbial gold, and a paint-by-number type of employee may not be a right fit for this role.
7. You get what you pay for.
Don’t expect to get the candidate with the most experience (the one you want, perhaps) by paying entry level wages. If you want the best, you're going to have to pay for the best. Alternatively, if you're on a budget, you may be better served by hiring someone who's a little less qualified, yet coachable.
When it comes the actual issue of pay:
Study the market to develop a fair amount;
Pay more than the minimum and less than the highest rate;
Salaries should be competitive, but not at the top of the pay scale.
8. Plan for the future.
Think for the long term during your hiring process, and try to focus on folks who have a mindset geared to the long-term success of the employer rather than short-term wins. You're trying to find folks who will be with you for the long haul and help you build your practice. Also, since employee turnover is costly to a dental practice, not hiring for the long term can lead to a great deal of upheaval and chaos, and even the patients can begin to feel the pain.
With a little prep and some diligence, you can hire the best individual for one of the most important positions within your practice. Take the proper time to find the right candidate, not just the first one or the most convenient. Your practice’s revenue stream depends on it.
Lindy Benton is CEO and president of Vyne, a provider of secure healthcare communications, electronic attachment and health information exchange solutions for hospitals and dental practices. Vyne serves more than one million providers in the U.S.