Under CBO Leader supervision; the Orthodontic Insurance Specialist provides support for Orthodontic insurance billing/ receivables by performing a broad spectrum of duties that includes interacting with insurance companies and providing support to dental practices as it relates to Orthodontia.
DUTIES AND RESPONSIBILITIES
Calling Insurance Carriers, or any other practical research resources (i.e. computer search tools), verify claim has been received and what the outcome paid and or denial reason is
Update all patient accounts to correct inaccurate information i.e. demographic, eligibility dates, termination date and contract allowable and or maximum.
Responsible for managing workflow of the assigned accounts and prioritizing the issues to meet all deadlines for filing to obtain maximum reimbursement.
Understand and stay informed of changes with the procedures and laws for specific insurance carriers or payers.
Meet or exceed established production and quality standards
Establish and maintain an accurate understanding and application of departmental policies and procedures in regards to daily assignments.
Maintain acceptable levels of attendance and punctuality as specified in company and departmental policies.
Meet routine deadlines and work schedules as well as timely and accurate completion of special projects and any other duties as assigned.
Understand, support, enforce and comply with company policies, procedures and Standards of business Ethics and Conduct.
Display a positive attitude as well as professional, polite, considerate and courteous conduct and treatment of others in the course of duties.
Audit insurance claims to identify and provide required attachments and audit attachments for completeness and suitability.
Work zero paid Orthodontic Explanation of Benefits (EOB) and take action to appeal or properly adjudicate claims.
Work partial paid Orthodontic Explanation of Benefits (EOB) and take action to appeal or properly adjudicate claims.
Ensure claim submission for secondary coverage within timely filing limits
Respond to office requests via company tools and/or phone.
Conduct full patient account audits to determine appropriate action.
Provide training and guidance to offices on proper Orthodontic contract and Orthodontic patient insurance record setup.
Build relationships and maintain open communication with dental office staff, internal departments and company representatives.
Provide appropriate greeting, guiding and gratitude (G3) in verbal and written communications.
High School diploma or equivalent
Associate's degree preferred.
Two or more year's recent collections experience in a dental or medical setting Orthodontics preferred
Knowledge of dental/medical industry and insurance plans (i.e. HMO, PPO, and Discount Plans) is strongly preferred.
The ability to read, speak and write in the English language in a clear and concise manner.
Pleasant and professional phone etiquette
Must possess excellent customer service skills.
Maintain professional composure both to internal and external sources.
Team member must be detail oriented, organized and work with little supervision.
Ability to multi-task effectively under stress, prioritize and meet deadlines with strong attention paid to detail of work produced.
Smile Brands Inc. and all relevant Affiliates are Equal Opportunity Employers.
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