Fee Schedule Administrator (Dental)

Position Summary:

The Fee Schedule Administrator is responsible for the accuracy, integrity, and ongoing maintenance of dental fee schedules across the organization. This role will independently research, validate, implement, and audit fee schedule configurations to ensure alignment with contracted reimbursement and payer adjudication.

The Fee Schedule Administrator will work closely with Revenue Cycle Management, Payer Relations, Credentialing, and other cross-functional partners to identify reimbursement discrepancies, determine root cause, implement appropriate corrections, and develop proactive controls designed to prevent recurring revenue-impacting issues.

This position requires strong knowledge of dental reimbursement and fee schedule administration, attention to detail, sound judgment, and the ability to independently work through complex reimbursement and system configuration issues.

Essential Duties & Responsibilities:

• Administer and maintain dental fee schedules across multiple practices, payers, plans, and networks.
• Independently research, validate, and implement fee schedule corrections within the practice management system, maintaining appropriate documentation of changes and supporting rationale.
• Audit existing fee schedules against contracted reimbursement terms, payer documentation, historical adjudication, and other available source information.
• Investigate discrepancies between expected reimbursement and actual payer adjudication to identify potential fee schedule, payer mapping, plan configuration, downgrade, alternate benefit, or other reimbursement issues.
• Evaluate identified discrepancies for broader impact across offices, payers, plans, and procedure codes rather than addressing issues solely at the individual claim level.
• Partner cross-functionally with Payer Relations and Credentialing, as well as RCM and other internal teams, to obtain and validate contracted fee schedules, effective dates, payer and plan information, network relationships, and other documentation necessary to support accurate system configuration and reimbursement.
• Develop and maintain proactive processes for identifying fee schedule discrepancies, reimbursement variances, outdated configurations, and other potential revenue-impacting issues before they become widespread.
• Establish routine auditing and monitoring practices to support ongoing fee schedule accuracy and quickly identify emerging reimbursement trends or configuration issues.
• Perform root-cause analysis of recurring fee schedule and reimbursement variances and implement appropriate corrective actions.
• Maintain clear records of fee schedule updates, effective dates, affected payers/plans/offices, supporting documentation, and completed corrections.
• Quantify and report identified variances and financial impact when possible, including recurring trends and opportunities for revenue recovery or prevention of future revenue leakage.
• Support fee schedule review, validation, and configuration associated with new practice acquisitions, payer changes, new contracts, and organizational growth.
• Serve as an internal subject-matter resource regarding dental fee schedules, reimbursement configuration, and related payer adjudication issues.
• Support additional Revenue Cycle Management functions and special projects as needed based on organizational priorities and business needs.

Qualifications:

• Demonstrated experience administering dental fee schedules within a dental practice management system.
• Strong working knowledge of dental insurance reimbursement, PPO fee schedules, contracted allowances, downgrades/alternate benefits, payer adjudication, and common dental reimbursement methodologies.
• Experience researching reimbursement discrepancies using fee schedules, contracts, EOBs/ERAs, claims, and practice management system data.
• Denticon experience strongly preferred. Candidates with significant dental reimbursement expertise and demonstrated ability to quickly learn complex practice management systems will also be considered.
• Ability to independently research unfamiliar reimbursement or system issues, identify root cause, and implement accurate solutions with minimal oversight.
• Ability to distinguish between fee schedule/configuration issues and other causes of reimbursement variance.
• Strong attention to detail with the ability to manage high-volume data while maintaining accuracy.
• Strong organizational and documentation skills.
• Ability to collaborate effectively across RCM, Payer Relations, Credentialing, Operations, and other functional teams.
• Strong Excel skills, including the ability to organize, reconcile, filter, and analyze reimbursement and fee schedule data.
• Ability to prioritize competing needs and work independently in a remote environment.

Key Success Measures:

• Accuracy and completeness of fee schedules maintained within the practice management system.
• Timely identification, validation, and correction of fee schedule and reimbursement discrepancies.
• Reduction in recurring fee schedule-related reimbursement variances and preventable revenue leakage.
• Development and consistent execution of proactive fee schedule auditing and monitoring processes.
• Clear documentation of fee schedule changes, supporting rationale, and affected payers, plans, and practices.
• Effective identification of systemic issues and implementation of root-cause corrective actions.
• Timely support of fee schedule needs related to payer changes, new contracts, and acquisitions.
• Effective cross-functional collaboration with Payer Relations, Credentialing, RCM, and other internal partners.