Insurance Services Manager

University of the Pacific•Stockton, CA

About The Position

Primary Purpose Under the general supervision of the Director of Patient Financial & Revenue Cycle ( DPFRC ) manages the business activities of the main clinic, designated clinic programs and supervises the insurance processing team to support patient access, claims management, reimbursement, and collections functions of the department. Responsible for monitoring and managing staff adherence to national and payer specific claims processing regulations the accurate, timely and complete processing of insurance claims and posting of payment in compliance with university protocols. University of the Pacific recognizes that diversity, equity, and inclusion is foundational to the success of our valued students and employees. We prioritize policy and decision-making that demonstrates awareness of, and responsiveness to, the ways socio-cultural forces related to race, gender, ability, sexuality, socio-economic status, etc. impede or propel students, faculty, and staff. Essential Functions Manage and support operations related to the evaluation, processing, and handling of claims; assure that departmental, federal, and state specific standards are maintained and that claims are handled accurately and timely; plan future courses of action and management of the overall insurance/posting activities to ensure effective and efficient operations. Manage accuracy and keep up to date all insurance set-up information in AxiUm and Dolphin applications including but not limited to insurance companies, benefit plans, coverage templates, contract plans, billing provider information. Ensure accurate posting of all charges and patient payments daily; review/advise on accuracy and completeness of procedure codes, fee schedules and treatment notes. Review, monitor, and analyze claim activity reports for the Revenue cycle staff to include claim submission, production, billing, and accounts receivable; ensure insurance billers are monitoring and managing claim productivity. Reconcile and resolve financial issues with patients and resolve insurance grievances between insurance companies and patients. In collaboration with the DPFRC , develop and manage business policy/procedures for clinic operations; provide the Business Office with reports and reconciliations as necessary. In collaboration with the DPFRC manage all contracts and communications with Delta and any other approved contract providers; ensure timely annual filing of fees; create and maintain current documentation regarding policies for processing, billing, and collecting insurance. Set daily expectations; monitor performance to ensure that staff are meeting and/or exceeding established performance goals (production and quality). Oversee and manage clinic finance liaison, group practice patient care and insurance coordinators as part of the financial team to achieve optimal revenue capture through best practices and efficient forward-thinking use of technology and resources. Support the DPFRC and Clinical Financial Operations Manager to train students, faculty, and staff on proper protocols and procedures related to insurance. Act as a liaison between the School of Dentistry, insurance providers, and patients regarding status and eligibility for coverage; manage and resolve patient billing inquiries. Provide monthly summary reports to the Business Office; review clinic production and expenses; advise and make recommendations to ensure achievement of budget goals. Actively seek out and drive process improvement, automation, and cost-efficient initiatives related to clinic business activities. Perform all other duties as assigned by the Director of Patient Financial & Revenue Cycle.

Requirements

Knowledge of: Dental practice management.
Dental/Medical insurance credentialing
Demonstrated ability to manage time effectively, balance multiple priorities, and drive tasks and projects to successful completion.
Proven track record of navigating complex and urgent issues with clarity and efficiency.
Thorough knowledge of the practices, procedures, and core concepts within the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.
Dental terminology/treatment and insurance procedures.
Electronic dental billing systems.
Accounting/billing procedures.
Principles of management and supervision.
Principles of business communication, including interpersonal interactions and letter and report writing.
Microsoft Excel, Word, and Access.
Ability to: Communicate effectively with a diverse population of patients, students, staff, faculty and administration.
Produce professional and concise reports and written correspondence.
Analyze financial reports and make appropriate recommendations.
Ability to meet benchmarks in a fast-pace high-volume setting
Work independently with minimal supervision.
Provide effective leadership, training, and supervision.
Maintain confidentiality of information.
Manage multiple projects and consistently meet deadlines.
Experience: Minimum of five years dental insurance claims processing experience.
Minimum five years increasingly responsible management experience, preferably in a dental or medical office.
Minimum 5 years experience in Revenue Cycle Management.
Education: Bachelor’s degree in related field.

Nice To Haves

Ability to: Communicate effectively with a diverse population of patients, students, staff, faculty and administration.
Provide effective leadership, training, and supervision.
Demonstrate professional judgment in all situations.
Experience: Experience in dental group practice or dental school highly desirable.
Bilingual skills helpful.
Other: Experience and sensitivity in working with people of diverse backgrounds and cultures.
Demonstrated experience in advancing social justice, equity, and inclusion in a university setting.
Ability to engage and integrate culturally responsive practices and knowledge in their work.

Responsibilities

Manage and support operations related to the evaluation, processing, and handling of claims
Manage accuracy and keep up to date all insurance set-up information in AxiUm and Dolphin applications
Ensure accurate posting of all charges and patient payments daily
Review, monitor, and analyze claim activity reports for the Revenue cycle staff
Reconcile and resolve financial issues with patients and resolve insurance grievances between insurance companies and patients.
In collaboration with the DPFRC , develop and manage business policy/procedures for clinic operations
In collaboration with the DPFRC manage all contracts and communications with Delta and any other approved contract providers
Set daily expectations; monitor performance to ensure that staff are meeting and/or exceeding established performance goals (production and quality).
Oversee and manage clinic finance liaison, group practice patient care and insurance coordinators as part of the financial team
Support the DPFRC and Clinical Financial Operations Manager to train students, faculty, and staff on proper protocols and procedures related to insurance.
Act as a liaison between the School of Dentistry, insurance providers, and patients regarding status and eligibility for coverage
Provide monthly summary reports to the Business Office
Actively seek out and drive process improvement, automation, and cost-efficient initiatives related to clinic business activities.
Perform all other duties as assigned by the Director of Patient Financial & Revenue Cycle.