Insurance Specialist

A global higher education leader in innovative teaching, research and public service, the University of North Carolina at Chapel Hill consistently ranks as one of the nation's top public universities. Known for its beautiful campus, world-class health care, commitment to the arts and top athletic programs, Carolina is an ideal place to teach, work and learn.

One of the best college towns and best places to live in the United States, Chapel Hill has diverse social, cultural, recreation and professional opportunities that span the campus and community.

University employees can choose from a wide range of professional training opportunities for career growth, skill development and lifelong learning and enjoy exclusive perks for numerous retail, restaurant and performing arts discounts, savings on local child care centers and special rates on select campus events. UNC-Chapel Hill offers full-time employees a comprehensive benefits package, paid leave, and a variety of health, life and retirement plans and additional programs that support a healthy work/life balance.

Primary Purpose of Organizational Unit

The primary purpose of this organizational unit is to provide patient business services to dental patients at the Dental Faculty Practice (DFP) and the undergraduate and graduate Student Dental Clinics (SDC) at the University of North Carolina School of Dentistry. Patient visits to DFP and SDC at UNC School of Dentistry number ~110,000 annually, generating annual gross revenue of approximately $18M.

The Patient Business Services (PBS) office supports multiple clinics, over 500 students/residents and over 100 faculty. PBS is an institutional support unit for the School of Dentistry, providing management support, decision support, financial analysis, account maintenance and faculty administrative support. PBS processes billing statements, provides phone support to patient inquiries about billing, and works with patients who require payment plans.

PBS ensures that payments from patients and private insurance providers, as well as collections of receivables from Medicaid, are timely and applied correctly. PBS acts as the main point of contact with the school's collection agency, identifying accounts for collections and responding to all collection inquiries. PBS also performs charge corrections, payment entry and other revenue adjustments as needed.

Knowledge of dental and medical terminology, dental procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing is required to respond to student and patient inquiries and to interact with insurance companies and Medicaid. The Patient Business Services Office researches accounts to determine action on over 5,500 active accounts for 8 Departments and generates all the accounts receivable reports distributed to the Departments of the Dental Faculty Practice, the pre-doctoral clinics, the eight graduate clinics and many other administrative offices.

Position Summary

This position performs dental and medical insurance services for the UNC Adams School of Dentistry. The Dental Insurance Specialist position works in all areas of billing and reimbursement from private dental and medical insurance companies.

This position requires specialized knowledge of the insurance industry standards relating to billing and reimbursement in order to perform position duties and a strong understanding of accounts receivable. This position works closely with private insurance carriers, particularly those contracting with the clinics. The position also requires an extensive and detailed understanding of dental and medical terminology, dental procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing of insurance policies and contracts for multiple insurance vendors.

The duties of this position include filing dental insurance claims and pre-treatment estimates for privately insured patients; obtaining and providing the clinical documentation necessary for claims processing, i.e. x-rays, chart notes and letters of necessity; investigating certain denied claims, following-up on those investigations and submitting claims appeals for those denied claims; scanning of such documentation in the electronic patient record as insurance cards, insurance explanation of payment, provider narratives and insurance consent and regularly auditing patient records for accuracy and completion of billing, coding, and clinical documentation. This position answers questions from patients and providers regarding dental insurance benefits, claim status and account summary, as well as assisting patients with in-house payment arrangements under the policies of the school advising patients of their options. This position requires HIPAA compliance.

Minimum Education and Experience Requirements

High school diploma or equivalency and one year of related office experience; or equivalent combination of training and experience.

Required Qualifications, Competencies, and Experience

This position requires oversight of all insurance related activity which requires a strong working knowledge of billing and third-party coverage including but not limited to private medical and dental insurance carriers, Worker's Compensation, Vocational Rehabilitation, and Veteran's Administration. This position also requires an extensive knowledge of current dental coding, medical coding and diagnosis coding including working knowledge of the new ICD-10 codes. Position requires thorough knowledge of university, state and federal regulations and statutes governing third party reimbursement.

Preferred Qualifications, Competencies, and Experience

Previous knowledge of and experience with financial control and accountability procedures; ability to maintain accuracy when dealing with high volume of transactions; Certified Dental Coder status; knowledge of the policies and procedures of the Dental Faculty Practice and Dental Student Clinics - at both the graduate and undergraduate levels - of the School of Dentistry as well as the policies and procedures of the Patient Business Services office; and excellent level of customer service under pressure are all preferred.

Required Licenses/Certifications Special Physical/Mental Requirements Campus Security Authority Responsibilities

Not Applicable.

Position/Schedule Requirements Overtime occasionally Special Instructions Quick Link https://unc.peopleadmin.com/postings/283381