Our Katy, TX client is seeking a contract to possible hire Dental Insurance Claims Specialist.
Responsibilities:
Receives, and performs review of dental claims for payment for benefits, checking for completeness and returning claims for additional information as appropriate
Verifies patient eligibility for coverage of claims received, checking appropriate records for birth date, social security number, date of eligibility, and type of coverage
Analyzes claims for possible discrepancies including duplication of services, duplication of billing, and incorrect procedure identification, recommending consultant review of claims as appropriate
Identifies applicable primary insurance carriers for claims received and coordinates payment of benefits with primary carriers
Calculates amounts payable for claims received, according to established guidelines; enters payment amounts into accounts payable records; and submits to appropriate authorities for approval
Prepares specific claims for pre-authorization requests for consultant review, preparing files and indicating policy limitations related to procedures being reviewed
Process pre-authorization requests, indicating consultant’s decision, calculating amount to be paid, and returning request to dentist office
Calculates premium costs for participating school districts, auditing school district enrollment adjustments and adjusting premium as appropriate
Processes and monitors enrollment forms of new employees and verifies eligibility and dependent information
Provides information regarding status of claims, dental plan benefits, and clarification of consultant’s review to staff, employees, school districts, insurance companies, and dental offices
Obtains information related to coordination of benefits, dental treatments, fees charged, and clarification of claims from staff, employees, school districts, insurance companies, and dental offices
Maintains accurate reports and prepares reports related to dental plan enrollment and dental claims received, paid, pending, and in-process
Processes and monitors accounts payable and receivable related to dental claims, making accurate postings to financial ledgers
Perform auditing of claims reimbursements, maintaining audit trails and ensuring proper fiscal controls
Operates internal accounting information systems, microcomputer hardware and software including spreadsheet and word processing programs
Serves as an information source or intermediary regarding dental insurance and dental claims
Performs related duties as assigned.
Requirements:
2-3 years of related experience
Basic knowledge of dental procedures and terminology
Establishment and maintenance of records and files
Modern office methods, practices, and procedures
Dental procedures and terminology
Standard office equipment including microcomputer, calculator, copier, and fax machine
Proper English usage including grammar, punctuation, spelling, and sentence structure
Communicate effectively in oral and written form
Identify problem areas or situations, determine problem causes, and take appropriate action to resolve identified problems
Make arithmetical calculations quickly and accurately and identify and correct errors in arithmetical calculations made by others
Operate standard office equipment and machines including microcomputer, copier, fax machine, and calculator
Effectively represent the County Office of Education in working with internal/external customers
Establish and maintain effective work relationships with those contacted in the course of assigned duties.
Please visit us on the web at www.frontlinesourcegroup.com
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Equal Opportunity Employer, M/F/V/D. Candidates must have authorization to work in the U.S. Clients will not sponsor visas.
Frontline Source Group™ is one of the fastest growing Information Technology, Accounting, Legal, Human Resources, Administrative, and Clerical staffing and direct hire firms with offices throughout Texas, Tennessee, and Arizona, with locations in: Austin, Dallas, Fort Worth, Plano, Houston Galleria, West Houston, Sugar Land, The Woodlands, Nashville, and Phoenix.
Frontline specializes in matching top talent with companies for direct, contract, and contract-to-hire placements. We work with clients and candidates in all areas of the United States and Canada.
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