Insurance Claims Specialist

At Risas Dental and Braces, our focus is providing quality and affordable dental care and braces for families everywhere. Our goal is to think and speak a language that patients understand. For this reason, our Company Statement is We Speak Patient™. The result is happier, healthier Patients, and better opportunities for our doctors and team members. 

We are seeking a dedicated, professional, and detail-oriented Insurance Claims Specialist to be part of our Risas team. Our Insurance Claims Specialists are empowered to deliver exceptional service and support to our many dental offices. Our Insurance Claims Specialist are responsible for interpreting plans, analyzing information, and processing medical claims for resolution and payment.  

Responsibilities:

• Analyze insurance claims and denials by running reports and contacting insurance carriers for claim resolution 
• Identify problem accounts or insurance providers, trends and escalate as appropriate 
• Responsible for correctly reading and interpreting insurance policies and benefits 
• Collect reimbursement by gathering, coding, and transmitting patient information, resolving discrepancies, and preparing reports 
• Maintain patient account records as needed and document any action taken 
• Generate appeals and grievance letters to explain reasons for appeals 
• Research/Identify coding or clinical issues and correct errors in a timely manner for maximum reimbursement 
• Resolve disputed claims by gathering, verifying, and providing additional information  
• Perform all types of complex adjustments to patient accounts and resolves any issues 
• Follow-up with insurance carriers via phone and web portals 
• Willingness to cross-train in additional departments i.e., payment posting or EDI support 
• Any additional duties and responsibilities as assigned 

Qualifications:

• High School Diploma or GED 
• Bilingual English/Spanish preferred 
• Experience with medical billing, dental billing, and accounts receivable preferred 
• Knowledge of understanding Explanation of Benefits (EOB), ADA forms, and insurance billing processes preferred 
• Proficient with M/S office products including Word, Excel, and Outlook 
• Excellent interpersonal, communication, and telephone skills establishing positive relationships 
• Commitment to providing exceptional service, support, and education to patients and teammates 
• Ability to think creatively, problem solve, and work independently 
• Must have a growth mindset and ability to adapt to change 

Benefits:  

Risas Dental and Braces offers a comprehensive benefits package including:   

• Medical and vision benefits   
• Free dental services  
• 401(k) with employer match  
• Paid Time Off 
• Tuition reimbursement opportunities  
• And many other ancillary benefits  

The working environment is fun, fast paced, challenging, and rewarding with opportunities for professional development and career advancement. Join us in this work. Begin a career that is full of meaning and value.