U.M. FDSP Associates, P.A.

Clinical Insurance Specialist

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Description/Job Summary

SUMMARY:
Under general supervision accurately and professionally clarifies and supports the administrative requirements of the various commercial patient DENTAL insurance plans. Additionally is accountable for a range of operational and administrative duties.
This is not an entry level position.
 

Responsibilities/Duties

ESSENTIAL DUTIES AND RESPONSIBILITIES:
  1. Investigate and research information in order to resolve dental insurance discrepancies. 
  2. Handle incoming calls including the processing of credit card payments over the phone. 
  3. Coordinate with Business Manager, Account Specialists, and Program Assistants the required dental insurance, paperwork, and dental x-ray documentation. 
  4. Contact the various dental insurance companies by phone in order to obtain missing or incomplete information so that accounts can be billed correctly. 
  5. Update Axium with new dental insurance plans as needed. 
  6. Verify patient insurance eligibility with numerous insurance companies including Medicaid. 
  7. Update patient dental insurance and personal information as needed. 
  8. Update third party liability through Medicaid to ensure the latest insurance revisions. 
  9. Obtain pre-authorizations from insurance companies to ensure patient is eligible for treatment prescribed by doctor. 
  10. Manage patient insurance plans and contracts including patient records, insurance templates, and master files. 
  11.  Rebill treatment and planned treatment to current insurance.  
  12. Run insurance  A/R report monthly. 
  13. Coordinate with dental providers to obtain necessary information (i.e. narratives, treatment notes) in order to submit accurate claims and to resolve disputes/appeals.

 

 

Note: The intent of this list of primary duties is to provide a representative summary of the major duties and responsibilities of this job.  Incumbents perform other related duties assigned.  Specific duties and responsibilities may vary based upon departmental needs.

 

 

Required Skills

Knowledge commercial insurance policies, services, guidelines, and procedures.
Skilled in dental terminology. 
Skilled in written disputes of non-payment for services due to processing errors.
Skilled in communicating insurance policies and procedures to patients and services providers.
Ability to ensure commercial insurance compliance and payment of services.
Ability to analyze insurance notification of changes in order to present plan participation recommendations to clinical financial administrator.
Ability to address complaints, grievances and appeals.

Preferred Skills

Knowledge commercial dental insurance policies, services, guidelines, and procedures.
Skilled in dental terminology. 
Skilled in written disputes of non-payment for services due to DentaQuest processing errors.
Skilled in communicating dental insurance policies and procedures to patients and services providers.
Ability to ensure compliance with the various dental insurance providers and payment of services.
Ability to analyze dental insurance notification of changes in order to present plan participation recommendations to clinical financial administrator.
Ability to annotate the oral dentition.

Required Education

High school diploma or general education degree (GED); 1 - 3 years’ related experience. 
Related education may be substituted for experience on a year for year basis.

Details

Overtime, weekend, on-call and shift work may be required.

This job description is designed to give an outline of what job duties are expected of this position. 
As an outline it does not fully describe or limit the extent of the position’s duties. 
The Corporation and its supervisors may amend the job description as it deems necessary, without advance notice. 
The job description is not intend to create an employment contract and should not be construed as such.

 

Starting salary is $17 an hour

 

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U.M. FDSP Associates. P.A. is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.