Job Title: Team Lead – Dental Insurance Verification & Revenue Cycle Auditing
Position Summary
The Team Lead – Dental Insurance Verification & Revenue Cycle Auditing is responsible for overseeing quality assurance, compliance, and performance auditing across dental insurance verification and the full revenue cycle process. This role ensures accuracy in eligibility verification, benefits breakdown, pre-authorizations, coding, claims submission, payment posting, and accounts receivable management.
The Team Lead will supervise audit staff, identify revenue leakage, reduce denials, ensure payer compliance, and drive continuous process improvement to maximize collections and operational efficiency across supported dental practices.
Key Responsibilities
Leadership & Team Oversight
Supervise and mentor QA/audit specialists supporting dental insurance verification and RCM teams.
Develop and manage audit schedules, sampling methodologies, and QA scorecards.
Conduct performance reviews, coaching sessions, and retraining initiatives.
Dental Insurance Verification Auditing
Audit patient eligibility and benefits verification.
Validate accuracy of fee schedules and network participation.
Ensure pre-treatment estimates are aligned with verified benefits.
Monitor pre-authorizations for major procedures (crowns, bridges, implants, ortho, etc.).
Ensure compliance with payer-specific dental policies.
Dental Revenue Cycle Auditing
Oversee the people conducting audits across the full dental billing lifecycle:
Claims Submission
Audit electronic and paper claim quality
Validate attachments (x-rays, perio charts, narratives)
Monitor clean claim rate
Denial Management
Analyze denial trends (frequency limits, downgrades, bundling)
Identify root causes and corrective actions
Ensure timely appeals and resubmissions
Payment Posting
Validate accurate insurance and patient payment posting
Ensure correct contractual adjustments
Monitor secondary billing accuracy
Accounts Receivable
Audit AR aging reports
Ensure timely follow-up on outstanding claims
Monitor overpayments and refund workflows
Compliance & Quality Assurance
Ensure adherence to HIPAA and payer regulations.
Maintain updated knowledge of ADA CDT coding updates and dental billing guidelines.
Develop QA scorecards and accuracy benchmarks.
Prepare audit reports for leadership with corrective action plans.
Reporting & Analytics
Track and report KPIs such as:
Clean claim rate
Insurance verification accuracy rate
Denial percentage
Net collection rate
Days in AR
Provide actionable insights to improve revenue integrity.
Present monthly QA and performance dashboards to leadership.
Required Qualifications
5+ years of experience in dental insurance verification and/or dental RCM.
2+ years of auditing, QA, or supervisory experience.
Strong knowledge of:
Dental insurance plans (PPO, DHMO, Indemnity)
CDT coding
Dental claims lifecycle
Coordination of Benefits (COB)
Dental fee schedules
Experience with dental practice management software (Dentrix, Eaglesoft, Open Dental, etc.).
Strong analytical and Excel reporting skills.
Excellent communication and leadership abilities.
