Insurance Specialist

UNC•Chapel Hill, NC

20h

About The Position

This Insurance Specialist position offers both dental and medical insurance services for the UNC Adams School of Dentistry. The Insurance Specialist works in all areas of billing and reimbursement, including private dental insurance companies and managed care organizations. This role requires specialized knowledge of insurance industry standards related to billing and reimbursement, along with a strong understanding of accounts receivable. This position collaborates closely with private insurance carriers, particularly those contracted with the clinics. It also requires a comprehensive understanding of dental and medical terminology, dental procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing, and the policies and contracts of multiple insurance vendors.

Requirements

Specialized knowledge of insurance industry standards related to billing and reimbursement.
Strong understanding of accounts receivable.
Comprehensive understanding of dental and medical terminology.
Comprehensive understanding of dental procedural and diagnostic coding.
Comprehensive understanding of medical-dental cross-coding.
Comprehensive understanding of electronic claims processing.
Comprehensive understanding of the policies and contracts of multiple insurance vendors.
Effective communication.
Deductive reasoning.

Responsibilities

Filing dental insurance claims and pre-treatment estimates for privately insured patients.
Obtaining and providing the clinical documentation necessary for claims processing, such as x-rays, chart notes, and letters of necessity.
Investigating denied claims, following up on those investigations, and submitting appeals for those denied claims.
Verifying essential documentation including insurance cards, insurance explanations of payment, provider narratives, and insurance consent.
Regularly auditing patient records for accuracy and completeness of billing, coding, and clinical documentation.
Extensive communication with various insurance companies.
Effective use of insurance portals.
Compliance with HIPAA regulations is mandatory.
Other duties as assigned.