Pre-Billing Specialist – Dental Insurance

Familia Dental & Vivid Smiles; Schaumburg (IL); Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Hybrid work schedule

Competitive compensation

Medical, dental, and vision insurance

Paid time off, sick leave, and paidH"

401(k) retirement plan

Life insurance

Job summary

Familia Dental is seeking a Pre-Billing Specialist with dental insurance experience to join its corporate support team. The role focuses on creating and maintaining insurance plans in the Practice Management System, assigning fee schedules, and ensuring correct patient estimates and reimbursements across clinics.

As proficiency grows, the position expands to include additional pre-billing, reimbursement, and credentialing duties, with comprehensive training provided.

Qualifications

• High school diploma or equivalent.
• Minimum 2 years in dental/healthcare insurance (billing/verification).
• Experience creating or maintaining insurance plans in PMS or billing system.
• Knowledge of fee schedules and in-/out-of-network applications.
• Proficiency with insurance carrier portals for plan, eligibility, benefits.

Responsibilities

• Create new insurance plans and employer profiles in the PMS for all clinics.
• Assign appropriate fee schedules based on payor, network, and contract terms.
• Modify existing plans to reflect coverage or plan changes.
• Review carrier verifications to ensure PMS plan data accuracy.
• Support clinics in attaching correct plans and benefits to patient accounts.
• Assist with plan setup and fee schedule issues and resolve errors promptly.

Skills

Attention to detail

Data entry

Verbal communication

Written communication

Microsoft Office

Education

High school diploma or equivalent

Tools

Denticon

Practice management system

Job description

Description

Position Summary

Familia Dental is seeking a Pre-Billing Specialist with dental insurance experience to join its corporate support team. The primary responsibility of this position is the creation and maintenance of insurance plans within the Practice Management System (PMS), including the accurate assignment of fee schedules. Accurate plan setup supports correct patient estimates, clean claim submission, and proper reimbursement across all Familia Dental clinics.

The Pre-Billing Specialist will work closely with the Billing and Operations departments. As the specialist gains proficiency, the role will expand to include additional pre-billing, reimbursement, and credentialing responsibilities, for which comprehensive training will be provided.

Requirements

Primary Responsibilities

• Create new insurance plans and employer profiles in the PMS for all Familia Dental clinics.
• Assign the appropriate fee schedule to each plan based on payor, network participation, and contract terms.
• Modify and update existing plans to reflect changes in coverage, fee schedules, or insurance type.
• Review insurance and carrier verifications to confirm the accuracy of plan data entered in the PMS.
• Support clinics in ensuring the correct plan and benefits are attached to patient accounts.
• Serve as a resource to clinic staff on plan setup and fee schedule assignments, and resolve related errors in a timely manner.

Additional Responsibilities (Training Provided)

• Maintain reimbursement rates and fee schedules for assigned payors.
• Analyze underpayments and overpayments, identify trends, and collaborate with the Billing department and payors to resolve discrepancies.
• Assist management with annual adjustments to the UCR (Usual, Customary, and Reasonable) Fee Schedule.
• Participate in contracted and non-contracted payor audits and report findings to the appropriate department.
• Research private and government payor rules and regulations specific to dental services.
• Support credentialing and payor enrollment for newly hired providers and maintain accurate enrollment records.
• Perform general office duties, including filing, answering telephones, and routine correspondence.
• Maintain compliance with HIPAA and all applicable regulatory requirements.
• Perform other duties as assigned.

Required Qualifications

• High school diploma or equivalent.
• Minimum of two (2) years of dental or healthcare insurance experience (e.g., insurance coordinator, insurance verification, billing, or claims).
• Demonstrated experience creating or maintaining insurance plans in a practice management or billing system.
• Working knowledge of fee schedules and their application to in-network and out-of-network plans.
• Proficiency with insurance carrier portals for plan, eligibility, and benefit information.
• Exceptional attention to detail and accuracy in data entry.
• Effective written and verbal communication skills.
• Knowledge of HIPAA regulations and a commitment to patient confidentiality.
• Proficiency in Microsoft Office (Word, Excel, Outlook).

Preferred Qualifications

• Experience with a dental practice management system, Denticon preferred.
• Experience with reimbursement analysis, payor audits, or UCR fee schedules.
• Experience with provider credentialing or payor enrollment.
• Experience in a multi-location dental practice or Dental Support Organization (DSO).

About Familia Dental

Familia Dental is a Dental Support Organization with 35 offices across five states and more than 100 dentists providing comprehensive dental services, from general dentistry to orthodontics.

Benefits

• Competitive compensation
• Medical, dental, and vision insurance
• Paid time off, sick leave, and paid holidays
• 401(k) retirement plan
• Life insurance
• Hybrid work schedule
• Collaborative, team-oriented environment