Insurance Specialist

University of Colorado•Aurora, CO

2d•Onsite

About The Position

The School of Dental Medicine (SDM) has an opening for an Insurance Specialist. This role is responsible for accurate billing, coding, and reimbursement of third-party insurance and Medicaid claims in support of the clinical enterprise. The Insurance Specialist serves as a key resource for patients, students, faculty, and staff by providing guidance on insurance coverage, financial responsibilities, and claims resolution. The position focuses on verifying eligibility and benefits, coordinating authorizations, reviewing and submitting claims, monitoring payments, and preparing appeals for denied claims. Using the Electronic Health Record system and reporting tools, the Insurance Specialist analyzes claim activity, ensures compliance with billing guidelines, and works closely with clinic managers and insurance carriers to promote timely reimbursement and a positive patient financial experience.

Requirements

Bachelor’s degree in business administration, finance, accounting, or a directly related field from an accredited institution
1 year of experience in billing, claims management or related experience in a medical, healthcare, higher education or dental setting.
A combination of education and related technical/military/paraprofessional experience may be substituted for a bachelor’s degree on a year for year basis.
Applicants must meet minimum qualifications at the time of hire.
Exceptional interpersonal skills
Demonstrated ability to communicate and maintain positive interpersonal relationships within a diverse community
Excellent written and verbal communication skills
Strong organizational skills
Excellent computer skills
Excellent understanding of verifying, authorizing and processing of insurance claims
Knowledge in federal and state regulations
Excellent written and verbal communication skills
Experience with Word, Excel and Outlook

Nice To Haves

Dental terminology experience
Experience that reflects familiarity with PPO/EPO, Medicaid, and the American Dental Association (ADA) Code on Dental Procedures and Nomenclature
Experience that reflects working with electronic health records and insurance processing in either a medical or dental setting
Experience with CDT dental coding and dental terminology

Responsibilities

Ensure accurate billing and payment processing for all third-party insurance and Medicaid claims, including coding and reimbursement verification.
Establish and maintain operational standards and documentation for fiscal reporting and communication with clinic managers.
Utilize Electronic Health Records and Microsoft Office applications to facilitate documentation and reporting processes.
Verify patient eligibility and benefits, coordinate necessary authorizations for treatment.
Inform patients on financial responsibilities and clarify insurance coverage details.
Conduct interviews to gather financial and insurance information, ensuring data accuracy in the Electronic Health Record system.
Serve as a liaison between patients, insurance carriers, students, faculty and staff, addressing concerns and resolving discrepancies to maintain positive relationships.
Maintain up-to-date knowledge of insurance company policies, ensuring compliance with billing guidelines and optimizing claims submissions.
Apply proper billing techniques and coding practices to maximize reimbursement and minimize claim denials, actively seeking to understand and implement changes in insurance regulations.
Review and analyze claims for accuracy, identifying potential errors before submission to reduce denials.
Perform regular audits of patient accounts to ensure compliance with financial policies and proper documentation.
Monitor insurance claims by running reports and contacting insurance carriers to resolve unpaid claims promptly.
Prepare and submit timely appeals for denied claims, providing necessary documentation and follow-up.
Conduct training sessions for staff on billing procedures and insurance policies to ensure consistent practices across the department.