Insurance Specialist

Insurance Specialist

This Insurance Specialist position performs both dental and medical insurance services for the client. The Insurance Specialist position works in all areas of billing and reimbursement from private dental insurance companies as well as Managed Care companies. This position requires specialized knowledge of the insurance industry standards relating to billing and reimbursement in order to perform position duties and a strong understanding of accounts receivable. This position works closely with private insurance carriers, particularly those contracting with the clinics. The position also requires an extensive and detailed understanding of dental and medical terminology, dental procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing, and of insurance policies and contracts for multiple insurance vendors. The duties of this position include filing dental insurance claims and pre-treatment estimates for privately insured patients; obtaining and providing the clinical documentation necessary for claims processing, i.e. x-rays, chart notes, and letters of necessity; investigating certain denied claims, following-up on those investigations and submitting claims appeals for those denied claims; scanning of such documentation in the electronic patient record as insurance cards, insurance explanation of payment, provider narratives and insurance consent and regularly auditing patient records for accuracy and completion of billing, coding, and clinical documentation. This position answers questions from patients and providers regarding dental insurance benefits, claim status, and account summary, as well as assisting patients with in-house payment arrangements under the policies of the school advising patient of their options. This position requires HIPAA compliance.