Dental Insurance Specialist

2 weeks ago

Philippines Medva Full time

We are seeking a highly organized and detail-oriented U.S. Dental Insurance Specialist to join our team. The ideal candidate will have extensive knowledge of dental insurance policies, claims processing, and patient account management. This role requires strong communication skills, attention to detail, and the ability to navigate the complexities of insurance billing to ensure smooth and efficient insurance reimbursement processes.

Key Responsibilities:

1. Insurance Verification: Verify dental insurance coverage for patients, including confirming eligibility, benefits, and coverage limits prior to treatment.

2. Claims Submission and Follow-up: Submit accurate dental insurance claims to carriers in a timely manner, ensuring all necessary documentation is provided. Follow up on unpaid, denied, or underpaid claims to resolve any issues.

3. Insurance Coding: Utilize proper dental coding (CPT, CDT) for procedures and services rendered, ensuring compliance with insurance requirements and federal regulations.

4. Claims Dispute Resolution: Work directly with insurance providers to resolve claim denials, appeal underpayments, and address any discrepancies between claims and patient statements.

5. Patient Communication: Communicate effectively with patients regarding their insurance coverage, co-pays, deductibles, and out-of-pocket costs. Provide clear explanations of insurance benefits and billing details.

6. Billing Support: Assist the billing department with patient billing inquiries, and coordinate insurance payments and adjustments to patient accounts.

7. Documentation and Recordkeeping: Maintain accurate and up-to-date insurance records, including patient information, claim status, and correspondence with insurance companies.

8. Compliance and Regulation Adherence: Ensure compliance with all dental insurance regulations and policies, as well as maintaining confidentiality according to HIPAA guidelines.

9. Reporting: Prepare and submit insurance reports for management, including details on claims status, aging accounts, and overall insurance collection performance.

Requirements

1. Education: High school diploma or equivalent; Associate degree or certification in dental billing/insurance is a plus.

2. Experience: Minimum of 2 years of experience in dental insurance verification, claims processing, and billing. Knowledge of dental insurance plans (PPO, HMO, Medicaid, etc.) is essential.

Skills:

1. Proficient in dental insurance claim management software.

  1. Strong understanding of dental insurance policies, procedures, and coding (CPT, CDT).

  2. Excellent organizational and multitasking abilities.

  3. Strong attention to detail and problem-solving skills.

  4. Ability to communicate effectively with insurance companies, patients, and internal teams.

  5. Familiarity with HIPAA and healthcare privacy laws.

7. Certifications: Certification in dental insurance billing (e.g., Certified Billing and Coding Specialist, or other relevant certifications) is preferred but not required.

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