Insurance Coordinator - CBO

Triangle Family Dentistry•Wake Forest, NC

About The Position

The Insurance Coordinator ensures accurate and timely filing of dental claims for assigned offices and reports follow-up problems and issues to the dental office. The role reviews accounts receivable reports on an assigned rotation, follows up on outstanding insurance claims and balances, resolves problem EOBs and denials, and processes appeals as needed. Claims should be submitted within 48 hours of the date of service, and follow-up reports should be addressed within 48 hours of being sent. The coordinator also tracks outstanding insurance balances by category and reports completion to the OM. The position includes administrative and team responsibilities such as participating in special projects, covering for other Claims/AR Coordinators, assisting with training new CBO team members, contributing to 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; candidates with 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, discrepancies, or errors.
Strong verbal and written communication skills.
Ability to manage and prioritize multiple tasks, including claim processing, payment follow-up, and claim dispute resolution.
Proficiency with dental practice management software and other computer applications used for claim processing and administrative tasks.
Good customer service skills for professionally and empathetically addressing patient billing and insurance inquiries and concerns.
Ability to troubleshoot claim processing, billing, and insurance coverage issues.
Knowledge of and adherence to legal and ethical guidelines regarding patient privacy (HIPAA) and billing practices.

Responsibilities

Review clinical notes, x-rays, and account ledgers to ensure the information is consistent.
Create and submit electronic and paper claims, attaching necessary x-rays, notes, narratives, charting, and other supporting materials, including for orthodontic claims.
Send claims through the clearing house and manage invalid and rejected claims.
Submit claims within 48 hours of the date of service.
Report account or claim issues to the dental office through a follow-up report or assign them to the designated DO team member within the PMS, with answers and corrections expected within 48 hours.
Send an Urgent Weekly Report to the dental office when issues from a follow-up report remain unresolved.
File corrected claims triaged by the AR Specialist based on returned problem EOBs.
Manage accounts receivable reports on an assigned schedule and review accounts for outstanding insurance claims and balances.
Call and follow up with insurance companies regarding claim issues and non-payments.
Complete appeals and requests from insurance companies.
Review returned EOBs and manage information needed for appeals, missing information or attachments, corrected claims, and retractions.
Track outstanding insurance balances by category and report completion to the OM.
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.