Job Description

The Dental Insurance Coordinator plays a vital role in ensuring that dental patients receive accurate billing information, insurance claim processing, and verification services. This position is responsible for managing patient insurance details, processing claims, and working closely with insurance companies and dental office staff to ensure timely and correct reimbursements. The ideal candidate will have excellent communication skills, attention to detail, and a solid understanding of dental insurance procedures.

Key Responsibilities:

Insurance Verification & Eligibility:

• Verify patients' dental insurance benefits prior to treatment.
• Confirm eligibility and coverage by contacting insurance providers and reviewing patient plans.
• Advise patients of their insurance benefits, coverage, and any out-of-pocket costs.

Claim Processing:

• Submit accurate insurance claims to carriers in a timely manner.
• Follow up on claim status and resolve any issues that may delay payments.
• Submit pre-authorizations or pre-determinations when required by insurance providers.
• Ensure that all claims are correctly coded and comply with industry regulations.

Insurance Payments & Account Management:

• Post insurance payments and adjustments to patient accounts.
• Review insurance EOB (Explanation of Benefits) statements to ensure payments match the claims submitted.
• Work with patients and insurance companies to resolve discrepancies or denied claims.

Patient Communication and Treatment Planning:

• Communicate with patients regarding their insurance coverage, treatment options, and financial responsibility.
• Provide patients with estimates of out-of-pocket costs and payment options.
• Educate patients about insurance benefits, claims processes, and treatment-related questions.

Data Management & Record Keeping:

• Maintain up-to-date patient insurance records in the practice management system.
• Ensure compliance with confidentiality and HIPAA regulations when handling sensitive patient data.
• Track and report on outstanding claims, denials, and payment issues.

Collaboration with Dental Team:

• Work closely with the dentist, office manager, and clinical team to coordinate treatment plans and insurance approvals.
• Provide insurance information to clinical staff for accurate treatment planning and billing.
• Assist in patient scheduling when insurance verification is required for appointments.

Denial Management & Appeals:

• Investigate and resolve denied insurance claims, following up with insurance companies to request reconsideration or clarification.
• Prepare and submit appeal letters as needed to resolve denied claims.

Qualifications:

• High school diploma or equivalent; additional education or certification in dental billing or insurance is a plus.
• Previous experience in dental insurance coordination, billing, or a similar administrative role in a healthcare setting.
• Knowledge of dental insurance policies, procedures, and terminology.
• Familiarity with EagleSoft and Vyne Trellis.
• Strong attention to detail and organizational skills.
• Excellent communication skills, both written and verbal.
• Ability to work independently and as part of a team.
• Strong problem-solving skills and the ability to handle patient inquiries professionally.

Preferred Skills:

• Experience with ADA coding, ICD-10 codes, and CPT codes.
• Familiarity with common dental insurance carriers (e.g., Delta Dental, Cigna, Aetna, etc.).
• Knowledge of HIPAA regulations and patient confidentiality standards.

Physical Requirements:

• Ability to sit for extended periods.
• Prolonged use of computers and office equipment.

Working Hours:

• Full-time position, Monday through Friday some Saturdays (if a Saturday you will rotate a day off to ensure you get your 2 days off) Flexibility in hours may be required based on office needs.

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