Job Description
Overview
Tufts University School of Dental Medicine (TUSDM) offers one of the most forward-looking educational environments in dental medicine in the country. Revenue Cycle Operations (RCO) team supports patient care services revenue cycle management, along with other members of the Finance and Administration team, supports the financial management and administration of the dental school. This position reports directly to the Revenue Cycle Administrator and works closely with school clinics it supports: Dental Faculty Practice, Craniofacial Pain and Sleep Center, Oral Medicine, Oral and Maxillofacial Pathology and Tufts Dental Facilities, the Pre-doctoral (students), Postgraduate (residents) Specialty clinical treatment areas, which includes: Endodontics, Orthodontics, Periodontics, Prosthodontics, Pedodontics, Oral and Maxillofacial Surgery, AEGD and Geriatric Dentistry, as well as any needed revenue support for IRB clinical study patients and maintaining CITI certification.
What You'll Do Under limited supervision, the Insurance Coordinator:
- Is responsible for checking patient insurance eligibility, benefits, limitations and coverage.
- Is responsible for obtaining and tracking prior authorizations and following up with insurances, patients and internal teams.
- Documents/updates accounts regarding coverage guidelines and limitations.
- Answers eligibility and benefit coverage inquiries.
- Ensures patients understand, consent and are compliantly notified, having signed and consented to treatment costs and notified regarding estimated financial responsibilities, such as, deductibles, co-pays, co-insurance amounts and 100% financial responsibility for non-covered costs.
- Communicates with healthcare providers and insurances to ensure required standards and applicable laws are followed, upheld and compliantly met, including maintaining patient confidentiality.
- Ensures OR patients are properly processed via administrative pre-op steps and guidelines, including OR scheduling and manages OR calendar to maximize operating room utilization, while following and adhering to applicable standards and regulations.
- Ensures proper consents, waivers, financial responsibility collected in full, pre & prior authorizations and contacts patients to review, answering and responding to all patient, supported clinic/practice team members and provider inquires that are related to OR treatment, scheduling or any OR related aspects.
- When applicable, makes recommendations for resolutions and notifies/informs, if/when laws and or standards are updated or changed.
- This position’s role and responsibilities are deadline driven; requires accuracy and exceptional attention to detail.
- Playing an essential and key role in the Dental School’s revenue cycle management, the Insurance Coordinator has a direct impact on the clinic’s financial and claims outcomes success and acts as a back-up to revenue analytics team, assisting with answering phone calls.
- Performing pre-claims administrative tasks and performing other claims related duties, to assist in timely and accurate revenue cycle management outcomes.
What We're Looking For Basic Requirements:
- Bachelor’s Degree/Associate’s Degree OR High School degree/GED with 2 - 3 years of insurance benefits, eligibility and coverage experience.
- Must be customer service focused (internal and external), with excellent communication, attention to detail, exceptional organizational and interpersonal skills.
- Knowledge of dental/medical insurances, insurance processes, billing/healthcare compliance and insurance guidelines, rules, regulations and requirements.
- Working knowledge of prior authorizations, insurance verification, including accurate and timely communication to internal customers, and patients regarding eligibility, benefits and coverage.
- Needs to be driven.
- Excel knowledge.
- Innovative, independent, self-starter, a leader, team player, analytical intelligence, exceptional attention to detail.
- Healthcare business or insurance knowledge.
- Ability to effectively communicate technical information.
- Aptitude and willingness to learn and to drive change.
- Dental coder certification (CDC) required, or within 1 year of hire date.
Preferred Qualifications:
- Bachelor’s Degree preferred.
- Experience coordinating benefits.
- Certified Dental Coder (CDC) applicant with 4 - 6 years of medical/dental insurance verification or financial coordination experience in a fast-paced dental/medical healthcare setting.
- Knowledge of MassHealth, Medicare and commercial insurance regulations, guidelines and applicable federal/state healthcare laws.
- Expert axiUm software knowledge.
- Working knowledge of third-party billing.
Pay Range Minimum $26.40, Midpoint $31.40, Maximum $36.40
Salary is based on related experience, expertise, and internal equity; generally, new hires can expect pay between the minimum and midpoint of the range. #J-18808-Ljbffr
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