Dental Insurance Coordinator

Benefits:

• Paid time off

Position Summary
The Dental Insurance Coordinator is responsible for managing all insurance-related functions of the dental office, ensuring claims are submitted accurately and promptly, benefits are properly verified, outstanding claims are followed up on, and insurance payments are posted correctly. This position plays a key role in maintaining healthy accounts receivable and helping patients clearly understand their insurance benefits and financial responsibilities.


Key Responsibilities


Insurance Verification & Patient Benefits

• Verify dental insurance eligibility and benefits before patient appointments.
• Obtain detailed benefit breakdowns, including deductibles, annual maximums, frequencies, waiting periods, limitations, and exclusions.
• Confirm coverage for major procedures before treatment whenever possible.
• Enter and maintain accurate insurance information in Dentrix.
• Update insurance plans, fee schedules, and subscriber information as needed.
• Clearly communicate estimated insurance coverage and patient responsibility to the front desk and treatment team.

Claims & Billing

• Submit dental insurance claims accurately and within 24–48 hours of treatment.
• Ensure claims include all necessary procedure codes, narratives, X-rays, periodontal charting, and supporting documentation.
• Review claims for accuracy before submission.
• Submit corrected claims, appeals, and additional documentation when required.
• Monitor electronic claim reports and correct rejected claims promptly.
• Maintain accurate documentation of all insurance communications and claim activity.

Insurance Follow-Up & Accounts Receivable

• Review the insurance aging report consistently.
• Follow up on unpaid or outstanding claims, especially claims approaching or exceeding 30 days.
• Contact insurance companies regarding delayed, denied, or underpaid claims.
• Work denied claims and appeals promptly instead of allowing balances to remain unresolved.
• Identify recurring insurance problems and report them to management.
• Maintain organized documentation of follow-up dates, reference numbers, representatives spoken with, and expected resolutions.

Payments & EOBs

• Review EOBs/ERAs for accuracy.
• Post insurance payments, adjustments, and write-offs correctly.
• Confirm payments match contracted insurance allowances when applicable.
• Identify underpayments or incorrect adjustments and follow up with the carrier.
• Transfer remaining patient balances accurately after insurance processing.

Treatment & Patient Support

• Assist the Treatment Coordinator and front desk with insurance estimates.
• Explain benefits to patients in a clear and professional manner without guaranteeing insurance payment.
• Help resolve patient questions regarding claims, EOBs, insurance balances, and coverage.
• Obtain pre-authorizations or pre-treatment estimates when necessary.
• Coordinate with clinical staff when insurance companies request additional documentation.

Performance Expectations


The Insurance Coordinator is expected to:

• Maintain accurate and current insurance information.
• Submit 95–100% of clean claims within 24–48 hours.
• Follow up consistently on outstanding insurance claims.
• Keep insurance accounts receivable as current as possible, with strong focus on claims over 30 days.
• Correct rejected claims promptly.
• Minimize preventable claim denials caused by missing information or submission errors.
• Maintain accurate payment posting and insurance adjustments.
• Document all significant insurance communications in Dentrix.
• Communicate insurance issues to management before they become significant collection problems.

Required Skills

• Dental insurance verification and billing knowledge.
• Understanding of PPO plans, deductibles, annual maximums, frequencies, limitations, and coordination of benefits.
• Knowledge of CDT dental procedure codes.
• Experience with dental claims, EOBs/ERAs, pre-authorizations, appeals, and insurance aging.
• Dentrix experience strongly preferred.
• Strong organizational and follow-up skills.
• Excellent telephone and patient communication skills.
• Ability to multitask and meet deadlines in a busy dental office.
• Strong attention to detail and accountability.
• Bilingual English/Spanish preferred.

Accountability


The Dental Insurance Coordinator is responsible for ensuring that insurance revenue is not unnecessarily delayed or lost because of missed claims, lack of follow-up, inaccurate information, or preventable billing errors. The coordinator is expected to take ownership of insurance accounts from verification through final claim resolution and communicate unresolved issues to management promptly.