Clinical Insurance Specialist

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Description/Job Summary

The candidates for this position must have an exstensive background in commerical dental insurance. Under general supervision accurately and professionally clarifies and supports the administrative requirements of the various commercial dental patient insurance plans. Additionally is accountable for a range of operational and administrative duties.Please note that this position is not an entry level position.

Responsibilities/Duties

  1. Investigate and research information in order to resolve commerical dental insurance discrepancies.


  1. Handle incoming calls including the processing of credit card payments for commerical dental procedures over the phone.


  1. Coordinate with Business Manager, Account Specialists, and Program Assistants the required dental insurance, paperwork, and dental x-ray documentation.


  1. Contact the commerical dental insurance companies by phone in order to obtain missing or incomplete information so that accounts can be billed correctly.


  1. Update Axium with new commerical dental insurance plans as needed.


  1. Verify commerical patient dental insurance eligibility with numerous insurance companies including Medicaid.


  1. Update commerical patient dental insurance and personal information as needed.


  1. Update third party liability to ensure the latest dental insurance revisions.


  1. Obtain pre-authorizations from commerical dental insurance companies to ensure patient is eligible for dental treatment prescribed by dentist.


  1. Manage commerical patient insurance plans and contracts including patient records, insurance templates, and master files.


  1. 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 of commerical dental 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 commerical dental insurance policies and procedures to patients and services providers.


Ability to ensure commerical dental insurance compliance and payment of services. Ability to analyze commerical dental 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 commerical 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 commerical dental insurance policies and procedures to patients and services providers.

 Ability to ensure compliance with the commerical dental insurance providers and payment of services.

Ability to analyze commerical dental insurance notification of changes in order to present plan participation recommendations to clinical financial administrator.

Ability to annotate the oral dentition.

Required Experience

1 - 3 years’ related experience.  Related education may be substituted for experience on a year for year basis.

Required Education

High school diploma or general education degree (GED)

Details

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.  UM FDSP 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.




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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.