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Overview

Tufts University School of Dental Medicine (TUSDM) offers one of the most forward-looking educational environments in dental medicine in the country. The Medical and Dental Billing team (Clinic Billing Operations), along with other members of the Finance and Administration team, support the financial management and administration of the dental school. This position reports directly to the Billing Manager and works closely with the School Clinics it supports.

Clinic Billing Operations (CBO) supports patient care services billing for the Predoctoral, Postgraduate and Specialty clinical treatment areas of the School, as well as any needed billing support for IRB clinical study patients and maintaining CITI certification. The Postgraduate Clinics (residents) are the Specialty Clinics, which includes: Endodontics, Orthodontics, Periodontics, Prosthodontics, Pedodontics, Oral and Maxillofacial Surgery, Implant Center, Aesthetics, AEGD and Geriatric. CBO also supports Dental Faculty Practice, Craniofacial Pain and Sleep Center, Oral Medicine, Oral and Maxillofacial Pathology and Tufts Dental Facilities.

What You'll Do

Under limited supervision, the Insurance Coordinator:

• is responsible for checking patient insurance eligibility, benefits, limitations and coverage;
• obtains and tracks prior authorizations and follows 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.

When applicable, the Insurance Coordinator makes recommendations for resolutions and notifies/informs, if/when laws and or standards are updated or changed.

The Insurance Coordinator's role and responsibilities are deadline driven; requires accuracy and 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 billing outcomes success and acts as a back-up to the billing team, assisting with answering phone calls; performing billing administrative tasks and performing other billing 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 team members and patients regarding eligibility, benefits and coverage.
• Requires expert attention to detail and the ability to effectively communicate technical information, with an aptitude and willingness to learn and 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.