Job Description

Insurance Specialist

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.

The Insurance Specialist primary duty is to assist patients and staff with Medical Assistance inquiries. The person in this position will work with various clinics, providers and insurance representatives to successfully obtain pre-authorizations and submit patient claims. The Insurance Specialist must be knowledgeable of the State of Maryland Medicaid program and monitor the changes in the associated plans and policies. STRONG MEDICAID background preferred.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Verifying and entering dental insurance and communication with insurance companies.
2. Determining MA eligibility and obtaining proper identification from patients.
3. Must possess a strong knowledge of elementary principles and terminology of Medical Assistance rules and regulations regarding dentistry as well as the policies and procedures of the Associated Health Choice health maintenance organizations policies and procedures of State of Maryland Medicaid program and its associated plans.
4. Monthly research of assigned insurance accounts receivables to determine and resolve any outstanding problems with claims and resubmit claims as needed.
5. Answer patient, students, and staff inquiries regarding MA dental insurance by phone or in person.
6. Manually submit pre-authorizations & claims as required by insurance with appropriate attachments
7. Determine and resolve problems with claims rejected by the EDI submission system.
8. Create a daily check log in Excel
9. Preparing daily deposit of checks which will include copies of all checks, completed daily deposit summary, and bank deposit report from axiom.
10. Research explanation of benefits (EOB's) for proper patient and insurance code information.
11. Reconcile checks.
12. Post all payments to proper to the correct patient account, allocate payments to the correct treatment, apply the correct discounts, courtesies, and write-offs or transfers as indicated by appropriate insurance policy.
13. Review patient accounts to detect any errors or inconsistencies. Check for accuracy and discrepancies and conduct appropriate research to resolve discrepancies. Include any notes, making adjustments or prepare refund requests.
14. Work with program assistants in various clinics to ensure accurate entering of patient insurance information.
15. Maintain manual and automated record systems.

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.

EDUCATION and/or EXPERIENCE:

High school diploma or general education degree (GED).

Required Knowledge / Skills / Abilities:

At least three years accounting clerical experience. Experience working with automated clinical information systems and Microsoft Office products (Excel and Word). Skill in performing mathematical computations, reviewing and processing financial documents, reconciling financial data, operating calculator, and manual and automated office equipment. Candidate must have the ability to communicate effectively both orally and in writing, prepare written records and reports, and work effectively in a team environment. Additional duties as assigned. This position entails daily public contact.

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. UM FDSP Associates P.A. 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.

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