Job Title

Insurance Verification Specialist

Department

Operations

Job Code

Supervisor

Regional Manager

Location

City, GA

FLSA Status

Nonexempt

Grade

Version

04242024

Job Description

Purpose and summary of role

The Insurance Verification Specialist is a foundational role in the daily activities of the Revenue Cycle Department. This role is responsible for Medicaid and Commercial insurance verifications. This role is responsible for updating practice management systems to ensure accurate estimates are given at time of service. This role is responsible for ensuring insurance verifications are accurate, timely, and all necessary information is accounted for especially pertaining to insurance coverage. This role is responsible for the tracking and reporting of daily activities. This role is responsible for follow-up with patients when unable to complete an insurance verification to ensure updating information is gathered.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. In accordance with the Americans with Disabilities Act, it is possible that requirements may be modified to reasonably accommodate disabled individuals. However, no accommodations will be made which may pose serious health or safety risks to the employee or others or which impose undue hardships on the organization.

Minimum Eligibility Requirements

• Requires basic knowledge of Medicare, Medicaid and Third-Party billing.
• Must have data processing skills
• Basic understanding of requirements and regulations set forth by Medicaid, and other related agencies.
• Must be able to communicate with sensitive and confidential information.
• Must be detail oriented and organized
• Possess excellent customer service skills and work well under pressure
• Strong computer skills including Microsoft Office suite
• Ability to multi-task, meet deadlines, and work in a fast-paced environment
• Ability to work independently as well as with a team
• Excellent verbal, written, and interpersonal skills
• Must pass criminal background check

Preferred Experience

• 1-year experience in healthcare industry positions, preferably in dental accounts receivable
• Experience with Eaglesoft, Dentrix, and Cloud9

Required Skills and Abilities

• Dental Practice Management, Clearinghouse and Analytic Systems
• Ability to apply logical or scientific thinking to define problems, collect data, establish facts, and draw conclusions.
• Able to interpret a variety of technical instructions and can deal with multiple variables.
• Ability to compute discount, interest, price, ratio, proportion and percentage.
• Strong planning and organizational skills
• Ability to communicate effectively and tactfully with all levels of personnel
• Experience with practice management, documents storage and claims processes
• Communicates problems directly, not engaging in rumors or gossip.
• Embraces a “Team-First” vs. “Me-First” attitude
• Always tries to do what’s right

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Conducts job duties in accordance with the Corporate Values and Culture
• Participate in office and Company initiatives.
• Universal Respect
• Understanding without judgement
• Takes ownership of role, manages with intellectual honesty, and willing to admit mistakes
• Functions in a fail-safe environment that forgives and focuses on solutions
• Follow, communicate and serve as a role model for company policies, procedures and the company’s objectives
• Reinforce Company Culture and Values; by creating a customer experience of the highest quality
• The job description provides a framework for the job, other duties may be assigned as necessary

Required Competencies

• Accounting and Reporting
• Reconciliation and Analysis
• Revenue Cycle Lifecycle
• Logical Thinking
• Communication

Work Environment

While performing the duties of this job, the employee regularly works in an office setting.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to use hands and fingers to handle, feel, or operate objects, tools or controls, and reach with hands and arms. The employee is frequently required to stand, talk and hear.

• FINGER DEXTERITY: Using primarily just the fingers to make small movements such as typing, picking up small objects, or pinching fingers together.
• TALKING: Especially where one must convey detailed or important instructions or ideas accurately, loudly, or quickly.
• AVERAGE HEARING: Able to hear average or normal conversations and receive ordinary information.
• AVERAGE VISUAL ABILITIES: Average, ordinary visual acuity necessary to prepare or inspect documents or products or operate machinery.
• PHYSICAL STRENGTH: Sedentary work. Sitting most of the time. Exerts up to 10 lbs. of force occasionally. (Almost all office jobs.)

Position Type and Expectations of Work Hours

This is a full-time position. Days and hours of work are Monday through Friday 40-50 hours a week.

Travel

Some travel to various practices may be required.

Signatures
The employee signature below constitutes the employee's understanding of the requirements, essential functions and duties of the position. This document is not considered an Employment Agreement. All employment with Southern Dental Alliance is at will, additionally, employment with the practice is and shall remain at will. This means that employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the employee, the practice or the company. Terms and conditions of employment with the company may be modified at the sole discretion of the company with or without cause and with or without notice.

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Employee Signature Date

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Print Name (Employee)