Insurance Coordinator - CBO

Lightwave Dental•Wake Forest, NC

3d•$19 - $23

About The Position

Triangle Family Dentistry is seeking an Insurance Coordinator for its Central Business Office. The role ensures accurate and timely filing of dental claims for assigned offices and reports claim problems and issues to the dental office. The coordinator reviews Accounts Receivable reports on an assigned rotation, follows up on outstanding insurance claims and balances, addresses problem EOBs and denials, and processes appeals as needed. Claims should be submitted within 48 hours of the date of service, and claim or account issues should be communicated to the dental office or designated team member for resolution. The position also supports administrative operations by participating in projects, filling in for other Claims/AR Coordinators, helping train new CBO team members, attending monthly meetings, and reporting grievances or issues to CBO-RCM.

Requirements

Previous experience in dental office administration, dental billing, or insurance claims processing is highly beneficial; medical claims processing experience may also be considered.
Familiarity with dental terminology and procedures.
Understanding of dental insurance policies, coverage limitations, claim submission procedures, common insurance codes such as CDT codes, and claim forms such as the ADA dental claim form.
Strong attention to detail when reviewing claims and identifying missing information or discrepancies.
Strong verbal and written communication skills.
Ability to manage and prioritize multiple tasks, including claim processing, payment follow-up, and dispute resolution.
Proficiency with dental practice management software and other computer applications used for claim processing and administrative tasks.
Customer service skills for addressing patient billing and insurance questions professionally and empathetically.
Ability to troubleshoot claim-processing issues, billing errors, and insurance coverage discrepancies.
Knowledge of and adherence to HIPAA and legal and ethical guidelines for patient privacy and billing practices.

Responsibilities

Review clinical notes, X-rays, and account ledgers for consistency.
Create and submit electronic and paper claims, including orthodontic claims, with necessary supporting documentation such as X-rays, notes, narratives, and charting.
Send claims through the clearinghouse and manage invalid or rejected claims.
Submit claims within 48 hours of the date of service.
Report account or claim issues to the dental office or designated DO team member through a follow-up report in the practice management system, with the expectation that answers or corrections are made within 48 hours.
Send an Urgent Weekly Report to the dental office when follow-up report items remain unresolved.
File corrected claims triaged by the AR Specialist based on returned problem EOBs.
Review assigned Accounts Receivable reports and follow up on outstanding insurance claims and balances.
Contact insurance companies regarding claim issues and non-payment.
Complete appeals and fulfill requests from insurance companies.
Review returned EOBs, including denials requiring appeals or missing information and attachments, corrected claims, and retractions.
Track outstanding insurance balances by category and report to the OM when completed.
Participate in special projects and tasks as assigned.
Fill in for other Claims/AR Coordinators as needed.
Assist with and conduct training for new CBO team members.
Attend and contribute to monthly meetings.
Report grievances or issues to CBO-RCM.