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