Insurance and Billing Coordinator

Job Title: Insurance and Billing Coordinator

Job Type: Full-Time

Pay: $25-30 per hour (Depending on Experience)

Location: Grand Junction, CO

Position Summary  

The Dental Insurance Coordinator is responsible for managing the insurance and claims process from eligibility verification through final claim resolution. This role helps ensure accurate billing, timely reimbursement, and a positive patient experience by maintaining accurate insurance information, submitting clean claims, following up on outstanding balances, and serving as a resource for patient insurance and billing questions. 

Key Responsibilities Insurance Eligibility & Benefits

• Verify patient insurance eligibility and benefits prior to appointments. 
• Review coverage details, frequencies, limitations, deductibles, maximums, waiting periods, and other plan restrictions. 
• Enter and maintain accurate insurance information within the practice management software including accurate fee schedules. 
• Update benefits and eligibility information when insurance plans change.
• Identify discrepancies or missing information before treatment whenever possible.

Insurance Claims

• Create, review, and submit dental insurance claims accurately and promptly.
• Ensure claims contain appropriate procedure codes, provider information, narratives, attachments, X-rays, periodontal charting, and other required documentation. 
• Review claims for accuracy before submission to reduce unnecessary denials or delays.
• Monitor claim status and respond to requests from insurance carriers for additional information. 

Insurance Payment Posting  

• Post insurance payments, EOBs, and EFTs accurately to patient accounts. 
• Apply payments, adjustments, write-offs, deductibles, and patient portions according to the appropriate fee schedule and office guidelines. 
• Review EOBs for accuracy and identify discrepancies between expected and actual reimbursement. 
• Correct posting errors and account discrepancies as needed. 

Outstanding & Aging Claims

• Review the insurance aging report routinely. 
• Follow up on unpaid, delayed, or denied claims. 
• Contact insurance carriers to determine claim status and document all follow-up activity. 
• Resubmit corrected claims and provide additional documentation when required.
• Work aging claims consistently to prevent outstanding insurance balances from becoming stagnant. 
• Escalate recurring reimbursement or carrier issues to leadership when appropriate. 

Claim Disputes & Appeals

• Review denied or underpaid claims to determine the appropriate next steps. 
• Prepare and submit claim reconsiderations, disputes, and formal appeals. 
• Gather supporting documentation, including clinical notes, X-rays, narratives, EOBs, and other records needed to support the claim. 
• Track disputed claims through resolution and follow up within appropriate timeframes.
• Document all communication and outcomes within the patient's account.

Patient Billing Support 

• Answer patient questions regarding insurance benefits, EOBs, account balances, and billing. 
• Help patients understand the difference between estimated insurance benefits and actual insurance payments.
•  Explain patient financial responsibility clearly and professionally. 
• Research billing concerns and account discrepancies and provide timely follow-up. 
• Partner with the administrative and treatment coordination teams when insurance issues may affect treatment or patient balances. 
• Send statements monthly. 

Expectations & Performance Standards  

The Dental Insurance Coordinator is expected to maintain accurate documentation, follow up consistently, and take ownership of claims through resolution rather than simply submitting them. Success in this position includes clean claim submission, accurate payment posting, low insurance aging, timely follow-up, and strong communication with both patients and the dental team. 

Qualifications

• Dental insurance or dental administrative experience is required. 
• Strong understanding of dental terminology, CDT codes, EOBs, insurance benefits, and claim processing. 
• Experience with Eaglesoft practice management software preferred.
• Strong attention to detail and organizational skills. 
• Comfortable communicating with insurance carriers and resolving complex claim issues. 
• Professional and confident when discussing billing and insurance questions with patients. 
• Ability to prioritize and manage multiple outstanding claims and deadlines independently.