Insurance Services Manager

Manage and support operations related to the evaluation, processing, and handling of claims; assure that departmental, federal, and state specific standards are maintained and that claims are handled accurately and timely; plan future courses of action and management of the overall insurance/posting activities to ensure effective and efficient operations. Manage accuracy and keep up to date all insurance set-up information in AxiUm and Dolphin applications including but not limited to insurance companies, benefit plans, coverage templates, contract plans, billing provider information. Ensure accurate posting of all charges and patient payments daily; review/advise on accuracy and completeness of procedure codes, fee schedules and treatment notes. Review, monitor, and analyze claim activity reports for the Revenue cycle staff to include claim submission, production, billing, and accounts receivable; ensure insurance billers are monitoring and managing claim productivity. Reconcile and resolve financial issues with patients and resolve insurance grievances between insurance companies and patients. In collaboration with the DPFRC, develop and manage business policy/procedures for clinic operations; provide the Business Office with reports and reconciliations as necessary. In collaboration with the DPFRC manage all contracts and communications with Delta and any other approved contract providers; ensure timely annual filing of fees; create and maintain current documentation regarding policies for processing, billing, and collecting insurance. Set daily expectations; monitor performance to ensure that staff are meeting and/or exceeding established performance goals (production and quality). Oversee and manage clinic finance liaison, group practice patient care and insurance coordinators as part of the financial team to achieve optimal revenue capture through best practices and efficient forward-thinking use of technology and resources. Support the DPFRC and Clinical Financial Operations Manager to train students, faculty, and staff on proper protocols and procedures related to insurance. Act as a liaison between the School of Dentistry, insurance providers, and patients regarding status and eligibility for coverage; manage and resolve patient billing inquiries. Provide monthly summary reports to the Business Office; review clinic production and expenses; advise and make recommendations to ensure achievement of budget goals. Actively seek out and drive process improvement, automation, and cost-efficient initiatives related to clinic business activities. Perform all other duties as assigned by the Director of Patient Financial & Revenue Cycle. Primary Purpose: Essential Functions: Manage and support operations related to the evaluation, processing, and handling of claims; assure that departmental, federal, and state specific standards are maintained and that claims are handled accurately and timely; plan future courses of action and management of the overall insurance/posting activities to ensure effective and efficient operations. Manage accuracy and keep up to date all insurance set-up information in AxiUm and Dolphin applications including but not limited to insurance companies, benefit plans, coverage templates, contract plans, billing provider information. Ensure accurate posting of all charges and patient payments daily; review/advise on accuracy and completeness of procedure codes, fee schedules and treatment notes. Review, monitor, and analyze claim activity reports for the Revenue cycle staff to include claim submission, production, billing, and accounts receivable; ensure insurance billers are monitoring and managing claim productivity. Reconcile and resolve financial issues with patients and resolve insurance grievances between insurance companies and patients. In collaboration with the DPFRC, develop and manage business policy/procedures for clinic operations; provide the Business Office with reports and reconciliations as necessary. In collaboration with the DPFRC manage all contracts and communications with Delta and any other approved contract providers; ensure timely annual filing of fees; create and maintain current documentation regarding policies for processing, billing, and collecting insurance. Set daily expectations; monitor performance to ensure that staff are meeting and/or exceeding established performance goals (production and quality). Oversee and manage clinic finance liaison, group practice patient care and insurance coordinators as part of the financial team to achieve optimal revenue capture through best practices and efficient forward-thinking use of technology and resources. Support the DPFRC and Clinical Financial Operations Manager to train students, faculty, and staff on proper protocols and procedures related to insurance. Act as a liaison between the School of Dentistry, insurance providers, and patients regarding status and eligibility for coverage; manage and resolve patient billing inquiries. Provide monthly summary reports to the Business Office; review clinic production and expenses; advise and make recommendations to ensure achievement of budget goals. Actively seek out and drive process improvement, automation, and cost-efficient initiatives related to clinic business activities. Perform all other duties as assigned by the Director of Patient Financial & Revenue Cycle. Minimum Qualifications: Knowledge of: Dental practice management. Dental/Medical insurance credentialing Demonstrated ability to manage time effectively, balance multiple priorities, and drive tasks and projects to successful completion. Proven track record of navigating complex and urgent issues with clarity and efficiency. Thorough knowledge of the practices, procedures, and core concepts within the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management. Dental terminology/treatment and insurance procedures. Electronic dental billing systems. Accounting/billing procedures. Principles of management and supervision. Principles of business communication, including interpersonal interactions and letter and report writing. Microsoft Excel, Word, and Access. Ability To: Communicate effectively with a diverse population of patients, students, staff, faculty and administration. Produce professional and concise reports and written correspondence. Analyze financial reports and make appropriate recommendations. Ability to meet benchmarks in a fast-pace high-volume setting Work independently with minimal supervision. Provide effective leadership, training, and supervision. Maintain confidentiality of information. Manage multiple projects and consistently meet deadlines. Experience: Minimum of five years dental insurance claims processing experience. Minimum five years increasingly responsible management experience, preferably in a dental or medical office. Minimum 5 years experience in Revenue Cycle Management. Education: Bachelor's degree in related field. Working Conditions: Position is full-time, 8 hours per day, 5 days per week. Preferred Qualifications: Ability to: Communicate effectively with a diverse population of patients, students, staff, faculty and administration. Provide effective leadership, training, and supervision. Demonstrate professional judgment in all situations. Experience: Experience in dental group practice or dental school highly desirable. Bilingual skills helpful. Other: Experience and sensitivity in working with people of diverse backgrounds and cultures. Demonstrated experience in advancing social justice, equity, and inclusion in a university setting. Ability to engage and integrate culturally responsive practices and knowledge in their work. Physical Requirements: Work performed is primarily office/administrative with frequent use of computer, mouse and telephone. Requires sitting majority of the working day; occasional standing, reaching, bending and walking. Hiring Range: Hiring Range: $99,289.34- $136,505.95 per year. We consider factors such as, but not limited to, scope and responsibilities of the position, candidate's qualifications, internal equity, as well as market and organizational considerations when extending an offer. Background Check Statement: All applicants who receive a conditional offer of employment are required to execute a release and authorization for a background screening. AB 810 Misconduct Disclosure Requirement: University of the Pacific complies with California Assembly Bill 810, requiring candidates accepting conditional job offers to disclose any final administrative or judicial findings, ongoing proceedings, allegations, resignations under investigation, or appeals related to sexual harassment or misconduct within the past seven years. #J-18808-Ljbffr University of the Pacific