Insurance Specialist

ECLARO; Chapel Hill (NC); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Job summary

A healthcare organization is seeking an Insurance Specialist to manage billing and reimbursement tasks, collaborate with private insurance carriers, and ensure compliance with industry standards. The role involves filing claims, verifying documentation, and communicating effectively with various insurance companies. A strong understanding of dental and medical terminology, alongside effective communication and deductive reasoning skills, is essential for success in this position. This is a 6-month contract with a possibility of extension.

Qualifications

• Knowledge of insurance industry standards related to billing and reimbursement.
• Experience with accounts receivable and electronic claims processing.
• Familiarity with dental procedural and diagnostic coding.

Responsibilities

• File dental insurance claims and pre-treatment estimates for privately insured patients.
• Investigate denied claims and submit appeals.
• Verify essential documentation including insurance cards and provider narratives.
• Audit patient records for accuracy in billing and coding.

Skills

Effective communication

Deductive reasoning

Knowledge of billing and reimbursement

Understanding of dental and medical terminology

Job description

Contract for 6 Months with possible extension

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.