Orthodontic Insurance Specialist

Smile Brands Irvine , CA 92606

Posted 2 weeks ago

Job Description:

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.


  • 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.

Required Qualifications:

  • 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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Orthodontic Insurance Specialist

Smile Brands