Affordable Care

Insurance Specialist/Trainer

US-NC-Raleigh
Job ID
2017-3513
Category
Healthcare Support

Overview

Position Summary:

Insurance Services Department Consultants share their expertise and give advice to ACI affiliated practice staff with the aim of optimizing Dental commercial insurance and Dental Medicaid participation.  They develop tools, deliver training, and provide on-going assistance to ensure practice level proficiency in plan administration and revenue maximization.  Affordable Care is a fast paced, energetic environment with dedicated professionals who are passionate and committed to the core values of the organization.

 

Responsibilities

Position Duties and Responsibilities:

  • Achieve mastery level expertise with dental commercial insurance and dental Medicaid plans in which ACI affiliated practices participate.  Act as liaison with plan representatives.
  • Author plan administrative tools (quick reference guides, checklists, etc.); training modules and the Dentrix system which is required for proficient practice administration.  Topics covered to include plan policy and coverage as well as general insurance administration.
  • Keep abreast of all policy and coverage changes; Dentrix and technological interfaces; and update all materials as required.
  • Conduct plan and general insurance training as well as Dentrix training to ACI affiliated practice staff.
  • Ability to achieve and maintain 80% satisfaction on training evaluations.
  • Update general insurance plans and Dentrix training materials as necessary.
  • Must be able to draw sound conclusions based on data analysis and communicate findings effectively, both in writing and virtually.
  • Achieve mastery level knowledge of Dentrix and all portal trainings.
  • Enter fee schedules and fee updates for all plans into Dentrix.
  • Conducting data analysis on healthcare claims and Medicaid utilization.
  • Provide on-going assistance to practice staffs in all areas of administration (technical and policy); this assistance to occur primarily via phone although occasionally on-site assistance may be required.
  • Troubleshooting and resolving practice issues related to plan policy, coverage; Dentrix and technological interfaces; and administration.
  • Act as a liaison with provider relations staff; maintain on-going dialogue and foster relationships to ensure timely response and problem resolution.
  • Policy plan administration; Dentrix; and perform other administrative tasks as required.
  • Maintain log of daily tasks as well as of practice calls taken and assistance provided.
  • Achieve defined departmental standards (response times, ACI code of conduct, etc.) and goals.
  • Providing project management support to Managers, team members, and other ACI staff.
  • Cross-train and be cross-trained on all key tasks associated with tool development, training, and administration; assist others in the department as necessary.

Qualifications

Qualifications

  • Expert knowledge regarding commercial dental insurance and dental Medicaid requirements, reimbursement rules, and the laws and regulations governing billing and collection activities. 
  • Epic Software experience is a major plus
  • Ability to interpret and effectively communicate insurance regulations.
  • Experience with all areas of dental insurance management (eligibility, filing, AR, etc).
  • Excellent verbal and written communication skills.
  • Ability to work independently and collaboratively within a team environment.
  • Ability to facilitate telephone, in-person, and/or web-based training sessions.
  • Excellent problem solving skills.
  • Well organized, accurate, and thorough.
  • Adaptable; readily adjusts work schedule to adhere to changes in the work environment and is able to manage competing demands.
  • Adept at prioritizing, planning work activities, and developing reasonable action plans.
  • Proficiency in all Microsoft Office products.
  • Customer service orientation.

 

Education and Experience Requirements:

  • Associates degree required, bachelor’s degree preferred.
  • Minimum five years commercial insurance or Medicaid experience preferred.

 

Computer Skills:                                                           

  • High degree of proficiency in a Microsoft Windows environment.
  • High degree of proficiency with dental software; Dentrix preferred.

 

Core Competencies: To perform the job successfully, an individual should demonstrate the following competencies to perform the essential functions of this position. 

  • Strong customer service orientation.
  • Ability to assess development needs of affiliated auxiliary practice staff.
  • Knowledgeable in creating and presenting training course material.
  • Must possess strong skills in the areas of interpersonal communication, analysis, critical thinking, attention to detail, multi-tasking, and oral & written communication.

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