Team Lead – Dental Insurance Verification & Revenue Cycle Auditing

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.