What are the responsibilities and job description for the Insurance & Billing Specialist position at The Oral Surgery Institute of the Carolinas?
Job Title: Insurance and Billing Specialist
Location:
Status: Non-Exempt
Reports To:
Position Summary:
The Insurance and Billing Specialist plays a vital role in supporting the financial health of the practice by managing all aspects of insurance verification, claims submission, and patient education. This position is responsible for ensuring accurate billing, timely reimbursement, and effective communication with insurance providers and patients. The ideal candidate will possess a deep understanding of dental and medical billing practices, coding, and insurance regulations.
Key Responsibilities:
Insurance Verification & Patient Communication
- Verify insurance eligibility, coverage details, limitations, and patient responsibility prior to treatment.
- Clearly communicate insurance benefits, financial obligations, and estimated costs to patients.
- Educate patients on insurance terminology and policies to promote financial transparency and understanding.
Claims Management
- Prepare and submit accurate claims for both dental and medical procedures using CDT, CPT, and ICD-10 codes.
- Review EOBs (Explanation of Benefits) to reconcile payments and resolve discrepancies.
- Monitor and follow up on outstanding or denied claims, submitting appeals with appropriate documentation as needed.
- Provide insurance predeterminations when necessary and coordinate patient follow-up and financial arrangements.
Documentation & Records
- Maintain up-to-date documentation in patient records regarding insurance benefits and claims activity.
- Submit supporting documents requested by insurance companies (e.g., x-rays, narratives, chart notes).
- Track and report insurance activity using practice management and EHR software.
Qualifications:
- Proven experience in insurance billing, claims, and coordination—preferably in a dental or oral surgery practice.
- Strong knowledge of insurance regulations, coding (CDT, CPT, ICD-10), and claims submission protocols.
- Proficiency in billing software and EHR systems.
- Excellent written and verbal communication skills.
- High attention to detail and strong organizational abilities.
- Ability to analyze and resolve billing discrepancies and denied claims.
- Customer service mindset with a patient-first approach.
