US Dental Insurance Specialist

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Requirements:

• 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.
• Proficient in dental insurance claim management software.
• Strong understanding of dental insurance policies, procedures, and coding (CPT, CDT).
• Excellent organizational and multitasking abilities.
• Strong attention to detail and problem-solving skills.
• Ability to communicate effectively with insurance companies, patients, and internal teams.
• Familiarity with HIPAA and healthcare privacy laws.

Responsibilities:

• Verify dental insurance coverage for patients, including confirming eligibility, benefits, and coverage limits prior to treatment.
• 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.
• Utilize proper dental coding (CPT, CDT) for procedures and services rendered, ensuring compliance with insurance requirements and federal regulations.
• Work directly with insurance providers to resolve claim denials, appeal underpayments, and address any discrepancies between claims and patient statements.
• 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.
• Assist the billing department with patient billing inquiries, and coordinate insurance payments and adjustments to patient accounts.
• Maintain accurate and up-to-date insurance records, including patient information, claim status, and correspondence with insurance companies.
• Ensure compliance with all dental insurance regulations and policies, as well as maintaining confidentiality according to HIPAA guidelines.
• Prepare and submit insurance reports for management, including details on claims status, aging accounts, and overall insurance collection performance.