Insurance Specialist

Primary Responsibilities

The insurance specialist is responsible for the insurance billing and follow up to aid in financial aspects of our orthodontic offices to allow the company to achieve its’ short term and long term objective, as determined by the leadership team. The insurance specialist is a key member and contributor to the success of the practice. This “attention to detail” position provides indepth support for all insurance related duties of the office. This position is responsible for accurate and complete entry of all insurance carriers and their benefits. These detail s will aid in all processing of insurance payments. Great interpersonal skills are required to build rapport and calling on those past due claims. They are also responsible for submitting letters and/or provider disputes to secure what benefits we can provide for our patients.

Duties

• Acts as a liaison between the organizations, its insurance provider, claimants and policy holders regarding their eligibility for coverage for all relevant claims
• Reviews benefit details to make sure that billing requirements are met, as well as daily electronic billing and paper billing of insurance claims
• View reports monthly and follow up on all past due claims
• Medi-Cal claim billing and follow up on all past due claims
• Generate narrative letters or provider disputes to secure any benefits
• Calling or writing the responsible party to collect any new policy details
• Answer any incoming calls from insured or responsible party with insurance concerns or questions

Tasks

• Ensure all information, whether from responsible party or insurance, are posted correctly for all offices
• Ensure all new insurance policies presented to the office have been called and certified for billing purposes
• Ensure there is contact made to the responsible party for all insurance declines or if additional information is required
• Ensure work environment is maintained in a safe and comfortable condition

Physical and Environmental Requirements

• May be required to lift up to 25 pounds (a box of copy paper or a bottle of the water for the cooler)
• Required ability to sit up to 6-8 hours per day with intermittent walking, standing or bending
• Vision: working 6-8 hours per day viewing a computer monitor, working on accounts, reading emails
• Hearing: Able to satisfactorily communicate by telephone with patients, doctors, and other staff members within HQ to ensure verbal communication is clearly understood, or a satisfactory-equivalent method of communication
• Finger dexterity is needed to access, enter and retrieve data using a computer keyboard