Insurance Coordinator and Credentialing Specialist-Dentistry Business Office

Job Description

Market Range: 06

Hiring Salary: $19.67/Hourly

Job Summary/Essential Functions

The Insurance Coordinator and Credentialing Specialist acts as the primary liaison between patients/clients and insurance providers, managing coverage verification, claim submissions, and financial arrangements. This position supports insurance-related revenue functions and ensures compliant billing and collections procedures. This position acts as a subject matter expert related to dental CDT coding and offers guidance and directives to residents, faculty, and staff.

Responsibilities

• Performs daily insurance eligibility verification. Notifies providers of eligibility restrictions, patient financial obligations, and provides directives on the use of compliant CDT coding.
• Performs daily audits on patient health records to ensure financial and coding accuracy, including the presence of complete and compliant chart documentation; initiates corrections and communicates errors to providers and staff; requests additional information or documentation as needed; monitors and notifies providers of missing charges.
• Proactively resolves payment issues by anticipating and identifying problems and coordinating appropriate solutions before claim submission; corrects fees on accounts as needed before claim submission; responds to payor requests for additional information for pending claims.
• Submits dental claims and pre-authorizations with required documentation in electronic, hard copy, or manual formats.
• Generates, researches, analyzes, and resolves aged insurance balances. Collects relevant correspondence, analyzes information, applies appropriate follow-up procedures timely.
• Process requests for patient claim reimbursement forms. Verify coding accuracy, documentation requirements and account charges; communicate necessary corrections to providers.
• Processes provider credentialing applications with commercial and governmental payors. Guides providers on necessary the steps to complete credentialing applications with CAQH profile.
• Collects and retains state licenses, DEA certificates, and practitioner specialty certificates.
• Performs other duties as assigned.
  
  

Qualifications

M INIMUM REQUIREMENTS:

Education

High School Diploma or GED. (TRANSCRIPT REQUIRED)

Experience

Four (4) years of public and private dental claims processing; OR Associate’s Degree and two years of public and private dental claims processing. (Five (5) years of dental claims processing in a high-volume setting is preferred.)

Knowledge, Skills, Abilities

• Knowledge of public and private dental insurance billing policies.
• Expert knowledge of dental terminology, treatment planning, and CDT coding.
• Knowledge of accounts receivable and collections processes.
• Ability to manage multiple job priorities and tasks efficiently, effectively, and accurately while demonstrating close attention to detail.
• Ability to communicate professionally and courteously with faculty, residents, students, patients, and staff.
• Ability to independently identify, research, and/or resolve financial conflicts with insurance companies and patient accounts.
• Ability to support and contribute to a positive and productive team environment.
• Advanced skills with the Microsoft Office suite.