Dental Intake & Eligibility Specialist

Job Description

Job Description

Description:

The Dental Intake & Eligibility Specialist is responsible for supporting the dental practice by managing patient intake, verifying insurance eligibility, processing dental claims, and performing front office administrative duties. This role ensures smooth patient flow, accurate billing, and timely reimbursement while delivering excellent customer service. 

 

Patient Intake & Front Office Duties

• Greet patients, check them in/out, and manage daily appointment flow.
• Answer phone calls, schedule appointments, route messages, and provide general information.
• Collect and update patient demographics, medical history, and consent forms.
• Explain treatment plans, financial policies, and payment expectations.
• Process payments, co-pays, and balances; post transactions accurately.
• Maintain the cleanliness and organization of the front desk and reception areas.
• Manage incoming/outgoing mail, faxes, and documents.

Insurance Eligibility & Verification

• Verify dental insurance eligibility prior to appointments (PPO, HMO, Medicaid, etc.).
• Determine covered benefits, annual maximums, frequencies, waiting periods, and limitations.
• Confirm patient costs such as deductibles, co-insurance, and co-pays.
• Obtain pre-authorizations and referrals when required.
• Enter verified insurance information into the system with accuracy and clarity.
• Communicate insurance findings to providers and help patients understand coverage.

Dental Claims & Billing Duties

• Create, review, and submit dental claims accurately with appropriate CDT codes.
• Attach required documentation such as X-rays, charting, and narratives.
• Monitor outstanding claims and follow up on unpaid or denied claims.
• Correct and resubmit denied claims as needed.
• Post Explanation of Benefits (EOBs) and reconcile patient accounts.
• Work with insurance companies to resolve discrepancies or claim issues.
• Assist with billing reports, adjustments, and aging accounts.

Requirements:

• High school diploma or equivalent.
• Experience working in a dental office or healthcare front office preferred.
• Strong computer competency, including MS Office, electronic health records, and document scanning.
• Strong understanding of HIPAA regulations.
• Experience with patient scheduling.
• Experience with the health insurance verification process and insurance billing, as well as payment data.
• Experience with the collection of patient intake data and patient registration.