Insurance Specialist

This Insurance Specialist position offers both dental and medical insurance services for the Client. The Insurance Specialist works in all areas of billing and reimbursement, including private dental insurance companies and managed care organizations. This role requires specialized knowledge of insurance industry standards related to billing and reimbursement, along with a strong understanding of accounts receivable. This position collaborates closely with private insurance carriers, particularly those contracted with the clinics. It also requires a comprehensive understanding of dental and medical terminology, dental procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing, and the policies and contracts of multiple insurance vendors. The responsibilities of this role include filing dental insurance claims and pre-treatment estimates for privately insured patients; obtaining and providing the clinical documentation necessary for claims processing, such as x-rays, chart notes, and letters of necessity; investigating denied claims, following up on those investigations, and submitting appeals for those denied claims; verifying essential documentation including insurance cards, insurance explanations of payment, provider narratives, and insurance consent; and regularly auditing patient records for accuracy and completeness of billing, coding, and clinical documentation. This position will require extensive communication with various insurance companies, along with effective use of insurance portals. Effective communication and deductive reasoning are essential skills. Compliance with HIPAA regulations is mandatory. Other duties as assigned.

Created: 2025-06-11