Position Summary: The Insurance Account Specialist will perform a broad spectrum
of duties that includes interacting with insurance companies and providing
support to dental practices as it relates to the collection of insurance
receivables. The primary goal of the Insurance Account Specialist is to ensure
the successful and timely collections of all dental service insurance claims.
This position will require constant contact with the insurance company
representatives, dental practices, and patients.
Process all insurance billing and EOBS
Coordinates and process payments from insurance carriers and troubleshoots any
issues related to those payments
Responsible for Insurance Aging Reports by calling insurance carriers and verify
if the claim has been received and what is the outcome of the claim
Investigate unpaid claims
Resubmit and appeal all problem claims
Process insurance claims to include required attachments daily by insurance
carriers to ensure timely payment of the claim
Monitor clearinghouse and clear out any validations errors, duplicates and
rejected claims daily
Work non-paid and partial EOBS and take action to appeal or properly adjudicate
Submit secondary claims with primary EOBS within timely filing limits
Responsible to maintain AR Days within standards
Update all patients accounts to as needed
Ensures all insurance related duties are completed in a timely and accurate
a manner to ensure excellent patient and client relations
Communicate compliance with daily reports of progress on achieving claims or
Process all Explanation of Benefits with correct PPO adjustments and write-offs
Meet or exceed established production and quality standards
Respond to office’s request
Conduct a full patient accounts audit to determine the best plan of action
(audit adjustments and write-offs)
Provide training and guidance to clients and co-workers when needed
Maintain open communication with office staff
Supervisory Responsibilities: This position does not have direct supervisory
Experience and Education:
High School diploma or equivalent
Associate’s degree preferred.
Two or more year’s recent dental billing required
Knowledge of CDT Coding and Terminology, a plus
Knowledge of dental software (Open Dental, Dentrix, or Eagle Soft) a plus
Ability to read dental radiographs, a plus.
Knowledge of dental/medical industry and insurance plans (i.e. HMO, PPO, and
Discount Plans) is strongly preferred.
The ability to read, speak and write in the English language in a clear and
Pleasant and professional phone etiquette
Must possess excellent customer service skills.
Maintain professional composure both to internal and external sources.
Team member must be detail oriented, organized and work with little supervision.
Ability to recognize tends and strategize resolutions
Ability to prioritize,and meet deadlines
with strong attention to detail.