RCM Insurance Verification Specialist

ROLE OVERVIEW

The Insurance Verification Specialist is responsible for accurately verifying patients' medical and dental insurance benefits and eligibility prior to their appointments. This role plays a critical part in ensuring a seamless billing process and positive patient experience by identifying coverage, obtaining authorizations requirements, and communicating clearly with both insurance carriers and patients.

KEY RESPONSIBILITIES

• Verify medical and dental insurance eligibility and benefits prior to surgical consultations and procedures.
• Obtain pre\-authorizations and pre\-certifications requirements for surgical treatments, including extractions, implants, bone grafting, and anesthesia services.
• Communicate with practices to explain coverage details, co\-pays, deductibles, and out\-of\-pocket responsibilities.
• Input verified insurance information into the practice management system with a high level of accuracy.
• Work closely with front desk, surgical coordinators, and billing staff to ensure timely scheduling and proper billing.
• Maintain up\-to\-date knowledge of payer\-specific requirements, especially those related to Oral Surgery, Medicaid, Medicare, and commercial plans.
• Assist in resolving insurance issues or denials related to authorization or eligibility.
• Support credentialing or contract updates when needed.

ESSENTIAL QUALIFICATIONS

• Prior experience in Dental Office workflows, Revenue Cycle functions to include Scheduling, Registration, Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow up and payment posting process
• Must be knowledgeable of reimbursement/compliance process and procedures with all payors
• In\-depth knowledge of CDT, CPT, AND ICD\-10 coding systems.
• Familiarity with policy order requirements for procedures and claim submissions.
• Ability to stay updated on changes in coding guidelines and reimbursement policies.
• Experience with practice management software systems, insurance portals, clearing houses, insurance guidelines, proficient in intermediate PC skills (MS Office—strong excel skills). Strong computer literacy, Excellent Math and problem\-solving skills. Data entry and 10\-key by touch.
• Strong interpersonal and organizational skills. Ability to work within a team setting and as an individual contributor.
• Excellent oral and written communication skills
• Responsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating procedures
• Excellent organization skills.
• Effective communication and interpersonal skills.
• Proficiency in relevant software applications and tools.
• Problem\-solving and critical\-thinking abilities.

What We Offer:

• Core Benefits \& Wellness
• Comprehensive Medical, Dental \& Vision Insurance (Virtual Care included)
• Confidential Employee Assistance Program (EAP) for you and your family

Financial Wellness

• Competitive Pay with Bonus Opportunities \& Annual Merit Increases
• 401(k) Retirement Plan with Company Match
• Health Savings Account (HSA) options with HDHP plans

Life Insurance Protection

• Company\-Paid Basic Life Insurance
• Optional Supplemental Life Coverage for You, Your Spouse \& Children

Time Away \& Life Balance

• Generous Paid Vacation (starting at 2 weeks!) \+ 6 Paid Holidays
• Short\- and Long\-Term Disability Coverage
• Supportive Leave of Absence Options