Insurance Coordinator

University of the Pacific; Stockton (CA); On-site; USD 42,000 - 54,000; Full time

Job summary

University of the Pacific in Stockton, CA seeks a Clinic Billing Specialist to process insurance claims, post payments, audit patient charts, and manage collections referrals. This role supports faculty, residents, and staff in ensuring accurate financial activity and timely reimbursements.

Must have a high school diploma and at least three years of high-volume dental billing and customer service experience.

Qualifications

• High school diploma or equivalent.
• Three consecutive years insurance billing and payment allocation in a high-volume dental setting.
• Three years customer service and/or patient relations.

Responsibilities

• Perform daily audit of patient health records for financial accuracy and complete treatment documentation.
• Prepare and generate insurance claims for submission (hard copy or electronic).
• Respond to insurer requests for information and facilitate resolution.
• Post and allocate insurance payments timely and accurately.
• Initiate refund requests to insurers for incorrect processing.
• Generate and review accounts receivable reports and identify write-offs or denials.
• Review claims for accuracy to ensure timely reimbursement across programs.
• Communicate insurance requirements and CDT updates to staff; collaborate with clinics.

Skills

Insurance billing

Accounts receivable

Customer service

CDT coding guidance

Confidentiality

Education

High school diploma or equivalent

Tools

Electronic health records software

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Primary Purpose

Under the supervision of the Clinic Manager, processes insurance claims and performs other related duties to include auditing of patient charts, posting of insurance payments, and collections referrals.

Essential Functions

• Perform daily audit of all patient health records to ensure financial accuracy and the presence of complete treatment documentation; initiate process of necessary corrections and communicate errors to the appropriate student, faculty, or staff member; request additional information and/or documentation as needed.
• Prepare and generate insurance claims for hard copy submission or batch electronic claims for electronic submission.
• Respond to requests from insurance companies for additional information and/or required documentation for pending claims; work with appropriate personnel to facilitate resolution.
• Post and allocate insurance payments timely and accurately based on explanation of benefits.
• Initiate refund requests to insurance companies due to incorrect processing of claims.
• Accurately process all financial recoups in a timely manner with thorough documentation.
• Generate and review accounts receivables reports; analyze information to determine appropriate financial write offs and adjustments, validity of insurance denial reasons, and patient financial responsibility; determine collectable balances and resolve appropriately; identify, audit, and refer delinquent accounts for collections.
• Review documentation and claims for accuracy in order to facilitate timely reimbursement of claims to include but not limited to private and government insurance programs, patient contracts, and special grant projects.
• Communicate insurance and policy requirement and regulations, reference materials and CDT updates to appropriate personnel; collaborate with internal and external clinics to establish constructive methods and procedures.
• Assist and provide guidance to students, residents, faculty, and staff regarding efficient and compliant CDT coding.
• Support processing needs of special grant programs and special discounts offered annually during mock boards.
• Perform all other duties as assigned by the Clinic Manager and/or Director of PHCC.
• University of the Pacific recognizes that diversity, equity, and inclusion is foundational to the success of our valued students and employees.
• We prioritize policy and decision-making that demonstrates awareness of, and responsiveness to, the ways socio-cultural forces related to race, gender, ability, sexuality, socio-economic status, etc. impede or propel students, faculty, and staff.

Minimum Qualifications

• High school diploma or equivalent.
• Three (3) consecutive years insurance billing and payment allocation in a high-volume dental setting.
• Three (3) years customer service and/or patient relations.

Preferred Qualifications

• Advanced private dental/medical insurance billing or general accounting policies and procedures.
• Basic accounting/billing procedures.
• Intermediate level dental terminology and treatment planning.
• Electronic health records software.
• Basic knowledge of Microsoft Word, Excel and Outlook.
• Manage multiple job priorities and tasks efficiently, effectively and accurately while demonstrating close attention to detail.
• Communicate professionally and courteously with faculty, residents, students, patients and staff.
• Maintain confidentiality of materials and information.
• Research and/or resolve financial conflicts with insurance companies and patient accounts.
• Support and contribute to a positive and productive team environment.
• Basic knowledge processing public dental insurance claims.
• Knowledge of medical terminology.
• Vocational or other training in the dental field highly desirable.
• Experience and sensitivity in working with people of diverse backgrounds and cultures.
• Demonstrated experience in advancing social justice, equity, and inclusion in a university setting.
• Ability to engage and integrate culturally responsive practices and knowledge in their work.
• Advanced private dental/medical insurance billing or general accounting policies and procedures.
• Experience and sensitivity in working with people of diverse backgrounds and cultures.
• Demonstrated experience in advancing social justice, equity, and inclusion in a university setting.
• Ability to engage and integrate culturally responsive practices and knowledge in their work.