RCM Insurance Verification Specialist

This is an in-person, M-F role at our West location: 7007 Old Sauk Road, Madison, WI 53717

www.oralsurgerymadison.com

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