Clinical Insurance Specialist MA Position Control Number CIS-23-920-03

U M FDSP Associates PA; Baltimore (MD); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health insurance

Paid time off

401(k) with employer match

Job summary

U.M. FDSP Associates is a nonprofit affiliate of the University of Maryland School of Dentistry, focused on staffing for clinic operations to support patient care by faculty and students.

The Insurance Specialist assists patients and staff with Medical Assistance inquiries and works with clinics, providers, and insurers to obtain pre-authorizations and submit claims. The role requires strong Medicaid knowledge, attention to detail, and effective communication.

Qualifications

• Three years of accounting clerical experience.
• Experience with automated clinical information systems and Microsoft Office (Excel and Word).

Responsibilities

• Verify and enter dental insurance information and communicate with insurers.
• Determine MA eligibility and collect patient IDs.
• Process pre-authorizations and claims with proper attachments.
• Resubmit denied claims and manage EDI issues.
• Create daily Excel check logs and deposit summaries.
• Post payments to patient accounts and apply adjustments.
• Reconcile checks and maintain patient records.
• Coordinate with clinics to ensure accurate insurance data.

Skills

Attention to detail

Communication skills

Teamwork

Problem solving

Education

High school diploma or GED

Tools

Excel

Word

EDI systems

Automated information systems

Job description

U.M. FDSP Associates is a non-profit affiliate of the University of MarylandSchool of Dentistry. U.M. FDSP Associates is the organization thatprovides patient care focused staffing for the clinic operations sothat faculty and students may provide patient care to the generalpublic

U.M. FDSP Associates is a non-profit affiliate of the University of MarylandSchool of Dentistry. U.M. FDSP Associates is the organization thatprovides patient care focused staffing for the clinic operations sothat faculty and students may provide patient care to the generalpublic.

We offer a comprehensive benefits package to support work-life balanceand employee well-being. Our benefits include:

• Time Off : Generous paid vacation,sick leave, and personal days, plus 17 paid Federal holidays. EnjoyThanksgiving Day and the Friday after Thanksgiving off, as well as a fullwinter break from Christmas Day through New Year’s Day.
• Health Coverage :Medical, dental, and vision insurance, along with short-term and long-termdisability, and life insurance options.
• Retirement : 401(k) with a competitiveemployer match of up to 6%.
• Work Schedule : Normaloperations hours are Monday through Friday.

We prioritize flexibility, health, and financial security, creating anenvironment where employees can thrive both professionally and personally.

The Insurance Specialist primary duty is to assistpatients and staff with Medical Assistance inquiries. The person in this position will work withvarious clinics, providers and insurance representatives to successfully obtainpre-authorizations and submit patient claims.The Insurance Specialist must be knowledgeable of the State of MarylandMedicaid program and monitor the changes in the associated plans and policies. STRONG MEDICAID background preferred.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Verifyingand entering dental insurance and communication with insurance companies.
2. DeterminingMA eligibility and obtaining proper identification from patients.
3. Mustpossess a know elementaryprinciples and terminology to understand and solve simple problems, orenough knowledge to undertake a task but not thoroughly familiarity. knowelementary principles and terminology to understand and solve simpleproblems, or enough knowledge to undertake a task but not thoroughlyfamiliarity. know elementary principles and terminology to understand andsolve simple problems, or enough knowledge to undertake a task but notthoroughly familiarity. strong knowledge of elementary principlesand terminology of Medical Assistance rules and regulations regardingdentistry as well as the policies and procedures of the Associated Health Choicehealth maintenance organizations policies and procedures of State ofMaryland Medicaid program and its associated plans.
4. Monthlyresearch of assigned insurance accounts receivables to determine andresolve any outstanding problems with claims and resubmit claims as needed.
5. Answerpatient, students, and staff inquiries regarding MA dental insurance byphone or in person.
6. Manuallysubmit pre-authorizations & claims as required by insurance withappropriate attachments
7. Determineand resolve problems with claims rejected by the EDI submission system.
8. Createa daily check log in Excel
9. Preparingdaily deposit of checks which will include copies of all checks, completeddaily deposit summary, and bank deposit report from axiom.
10. Researchexplanation of benefits (EOB’s) for proper patient and insurance codeinformation.
11. Reconcilechecks.
12. Postall payments to proper to the correct patient account, allocate paymentsto the correct treatment, apply the correct discounts, courtesies, andwrite-offs or transfers as indicated by appropriate insurance policy.
13. Reviewpatient accounts to detect any errors or inconsistencies. Check foraccuracy and discrepancies and conduct appropriate research to resolvediscrepancies. Include any notes, making adjustments or prepare refundrequests.
14. Workwith program assistants in various clinics to ensure accurate entering ofpatient insurance information.
15. Maintainmanual and automated record systems.

Note: The intent of this list of primary duties is toprovide a representative summary of the major duties and responsibilities ofthis job. Incumbents perform otherrelated duties assigned. Specific dutiesand responsibilities may vary based upon departmental needs.

EDUCATION and/or EXPERIENCE:

High school diploma or general education degree (GED).

Required Knowledge / Skills / Abilities:

At least three years accounting clerical experience.Experience working with automated clinical information systems and MicrosoftOffice products (Excel and Word). Skill in performing mathematicalcomputations, reviewing and processing financial documents, reconciling financialdata, operating calculator, and manual and automated office equipment. Candidate must have the ability tocommunicate effectively both orally and in writing, prepare written records andreports, and work effectively in a team environment. Additional duties asassigned. This position entails daily public contact.

ADDITIONAL CONDITIONS OF EMPLOYMENT:

This job description is designed to give an outline ofwhat job duties are expected of this position.As an outline it does not fully describe or limit the extent of theposition’s duties. UM FDSP AssociatesP.A. and its supervisors may amend the job description as it deems necessary,without advance notice. The jobdescription is not intended to create an employment contract and should not beconstrued as such.