Dental Clinical Insurance Specialist in the Specialty Clinics Position Control Number CIS-22-110-01

U.M. FDSP Associates is a non-profit affiliate of the University of Maryland School of Dentistry.  U.M. FDSP Associates is the organization that provides patient care focused staffing for the clinic operations so that faculty and students may provide patient care to the general public

U.M. FDSP Associates is a non-profit affiliate of the University of Maryland School of Dentistry.  U.M. FDSP Associates is the organization that provides patient care focused staffing for the clinic operations so that faculty and students may provide patient care to the general public.

We offer a comprehensive benefits package to support work-life balance and employee well-being. Our benefits include:

• Time Off: Generous paid vacation, sick leave, and personal days, plus 17 paid Federal holidays. Enjoy Thanksgiving Day and the Friday after Thanksgiving off, as well as a full winter break from Christmas Day through New Year’s Day.
• Health Coverage: Medical, dental, and vision insurance, along with short-term and long-term disability, and life insurance options.
• Retirement: 401(k) with a competitive employer match of up to 6%.
• Work Schedule: Normal operations hours are Monday through Friday.

We prioritize flexibility, health, and financial security, creating an environment where employees can thrive both professionally and personally.

Under general supervision accurately and professionally clarifies and supports the administrative requirements of the various commercial patient dental insurance plans. Additionally, is accountable for a range of operational and administrative duties.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Investigate and research information to resolve dental insurance discrepancies.

2. Handle incoming calls including the processing of credit card payments over the phone.

3. Coordinate with Business Manager, Account Specialists, and Program Assistants the required dental insurance paperwork and dental x-ray documentation.

4. Contact the various dental insurance companies by phone to obtain missing or incomplete information so that accounts will be billed correctly.

5. Update Axium with new dental insurance plans as needed.

6. Verify patient dental insurance eligibility with numerous insurance companies including Medicaid.

7. Update patient dental insurance and personal information as needed.

8. Update third party liability through Medicaid to ensure the latest dental insurance revisions.

9. Obtain pre-authorizations from insurance companies to ensure patient is eligible for treatment prescribed by doctor.

10. Manage patient dental insurance plans and contracts including patient records, insurance templates, and master files.

11.  Rebill treatment and planned treatment to current insurance. 

12. Run insurance A/R report monthly.

13. Coordinate with dental providers to obtain necessary information (i.e. narratives, treatment notes) in order to submit accurate claims and to resolve disputes/appeals..

Note: The intent of this list of primary duties is to provide a representative summary of the major duties and responsibilities of this job.  Incumbents perform other related duties assigned.  Specific duties and responsibilities may vary based upon departmental needs.

High school diploma or general education degree (GED); 1 - 3 years’ related experience.  Related education may be substituted for experience on a year for year basis.

Required Knowledge / Skills / Abilities:

Knowledge of commercial dental insurance policies, services, guidelines, and procedures.

 Skilled in dental terminology.  Skilled in written disputes of non-payment for services due to processing errors. Skilled in communicating insurance policies and procedures to patients and services providers.

Ability to ensure commercial dental insurance compliance and payment of services. Ability to analyze insurance notification of changes in order to present plan participation recommendations to clinical financial administrator. Ability to address complaints, grievances and appeals.

pERFERRED Knowledge / Skills / Abilities:

Knowledge commercial dental insurance policies, services, guidelines, and procedures.

Skilled in dental terminology.  Skilled in written disputes of non-payment for services due to DentaQuest processing errors. Skilled in communicating dental insurance policies and procedures to patients and services providers.

Ability to ensure compliance with the various dental insurance providers and payment of services. Ability to analyze dental insurance notification of changes in order to present plan participation recommendations to clinical financial administrator. Ability to annotate the oral dentition.

ADDITIONAL CONDITIONS OF EMPLOYMENT:

This job description is designed to give an outline of what job duties are expected of this position.  As an outline it does not fully describe or limit the extent of the position’s duties.  The Corporation and its supervisors may amend the job description as it deems necessary, without advance notice.  The job description is not intended to create an employment contract and should not be construed as such.