Dental Claims Coordinator-College of Dentistry

Job Summary/Essential Job Functions

The Dental Claims Coordinator oversees all dental insurance billing, claims processing, and provider credentialing for Kingsport Dental Clinic. This position ensures accurate, timely claims and pre-authorizations, focusing on services commonly required by patients with special health care needs.

Responsibilities

• Prepares and submits insurance claims and pre-authorizations (electronic and paper); monitors all unsubmitted or denied claims.
• Identifies and resolves payment issues proactively, coordinating with payers to obtain claim approvals.
• Audits patient records for accurate financial and CDT coding documentation; initiates corrections and communicates with providers to ensure compliant submissions.
• Collaborates with the hospital to create a streamlined process (create and monitor PAs, insurance coordination, and hospital coordination).
• Assists students, residents, and staff in understanding insurance protocols.
• Maintain up-to-date knowledge of CDT coding, Medicaid/Medicare rules, and payer regulations for dentistry.
• Explains treatment costs and insurance coverage.
• Performs other duties as assigned.

Qualifications

• Education: High School Diploma or GED. (TRANSCRIPT REQUIRED)
• Experience: Four (4) years of public and private dental claims processing; OR Associate’s Degree and two (2) years of public and private dental claims processing.
• Knowledge, Skills, And Abilities:
• Ability to organize and prioritize work to meet competing deadlines.
• Knowledge of special needs patient population guidelines, regulations, policy, and procedures.
• Knowledge of public and private dental insurance billing policies.
• Ability to manage multiple job priorities and tasks efficiently, effectively, and accurately while demonstrating close attention to detail.
• Expert knowledge of dental terminology, treatment planning, CDT coding, accounts receivable and collections processes.
• Ability to communicate professionally and courteously with faculty, residents, students, patients and staff.
• Ability to identify, research and/or resolve financial conflicts with insurance companies and patient accounts.