East Carolina University-posted 2 months ago
$34,602 - $49,406/Yr
Full-time • Entry Level
Greenville, SC
Educational Services

The position of Pre-Authorization Specialist is located in the School of Dental Medicine at Ross Hall. This role involves electronically submitting complex insurance claims that require attachments through specialized software or manually via online insurance portals such as NC Tracks for Medicaid. The specialist will gather all needed information from the Electronic Health Record to prepare and submit insurance pre-authorizations, track and enter pre-authorization results into billing and treatment records, monitor expiring pre-authorizations, and request extensions or new authorizations when needed. Additionally, the specialist will notify providers of pre-authorization results, conduct specialized training for incoming dental students, and train new/existing staff on specialized software. The role also includes reviewing remittance advice documents and EOBs to ensure proper processing and payment of claims, correcting data errors, resubmitting or appealing unprocessed claims, and analyzing patterns of difficulty in submission or approval to suggest corrective measures.

  • Electronically submit complex insurance claims that require attachments through specialized software.
  • Gather needed information from the Electronic Health Record to prepare and submit insurance pre-authorizations.
  • Track and enter pre-authorization results into billing and treatment records.
  • Monitor expiring pre-authorizations and request extensions or new authorizations.
  • Notify providers of pre-authorization results.
  • Conduct specialized training for incoming dental students and train new/existing staff on specialized software.
  • Review remittance advice documents and EOBs to ensure proper processing and payment of claims.
  • Correct data errors, resubmit or appeal unprocessed or returned claims.
  • Analyze patterns of difficulty in submission or approval and suggest corrective measures.
  • High school diploma or equivalency and one year of related office experience, or equivalent combination of training and experience.
  • Knowledge of dental patient accounts including claims, insurance processing, payment processing, write-offs, and adjustments.
  • Effective communication skills with clients, faculty, insurance company representatives, and staff.
  • Experience with insurance carrier billing procedures and protocols.
  • Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.
  • Dental office experience.
  • Eligibility to participate in the UNC Optional Retirement Program (ORP) with matching employer contributions.
  • Eligibility to participate in various Voluntary Supplemental Retirement Plans (401k, 403b, 457).
  • Multiple voluntary options for Medical, Dental, Vision, and Life Insurance.
  • Various supplemental plans including Critical Illness, Flexible Spending Accounts, Cancer, and Disability.
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