Insurance Coordinator and Credentialing Specialist-Dentistry Business Office

Insurance Coordinator And Credentialing Specialist

The Insurance Coordinator and Credentialing Specialist acts as the primary liaison between patients/clients and insurance providers, managing coverage verification, claim submissions, and financial arrangements. This position supports insurance-related revenue functions and ensures compliant billing and collections procedures. This position acts as a subject matter expert related to dental CDT coding and offers guidance and directives to residents, faculty, and staff.

Responsibilities

1. Performs daily insurance eligibility verification. Notifies providers of eligibility restrictions, patient financial obligations, and provides directives on the use of compliant CDT coding.
2. Performs daily audits on patient health records to ensure financial and coding accuracy, including the presence of complete and compliant chart documentation; initiates corrections and communicates errors to providers and staff; requests additional information or documentation as needed; monitors and notifies providers of missing charges.
3. Proactively resolves payment issues by anticipating and identifying problems and coordinating appropriate solutions before claim submission; corrects fees on accounts as needed before claim submission; responds to payor requests for additional information for pending claims.
4. Submits dental claims and pre-authorizations with required documentation in electronic, hard copy, or manual formats.
5. Generates, researches, analyzes, and resolves aged insurance balances. Collects relevant correspondence, analyzes information, applies appropriate follow-up procedures timely.
6. Process requests for patient claim reimbursement forms. Verify coding accuracy, documentation requirements and account charges; communicate necessary corrections to providers.
7. Processes provider credentialing applications with commercial and governmental payors. Guides providers on necessary the steps to complete credentialing applications with CAQH profile.
8. Collects and retains state licenses, DEA certificates, and practitioner specialty certificates.
9. Performs other duties as assigned.

Qualifications

MINIMUM REQUIREMENTS:

EDUCATION:

High School Diploma or GED. (TRANSCRIPT REQUIRED)

EXPERIENCE:

Four (4) years of public and private dental claims processing; OR Associate's Degree and two years of public and private dental claims processing. (Five (5) years of dental claims processing in a high-volume setting is preferred.)

KNOWLEDGE, SKILLS, ABILITIES:

• Knowledge of public and private dental insurance billing policies.
• Expert knowledge of dental terminology, treatment planning, and CDT coding.
• Knowledge of accounts receivable and collections processes.
• Ability to manage multiple job priorities and tasks efficiently, effectively, and accurately while demonstrating close attention to detail.
• Ability to communicate professionally and courteously with faculty, residents, students, patients, and staff.
• Ability to independently identify, research, and/or resolve financial conflicts with insurance companies and patient accounts.
• Ability to support and contribute to a positive and productive team environment.
• Advanced skills with the Microsoft Office suite.