Insurance & Billing Coordinator

BONITA FAMILY DENTAL
Sandhya Hegde, D.D.S., Inc.
JOB DESCRIPTION — BILLING / INSURANCE COORDINATOR
$30-$35 per hour 4 days a week up to 9.5 hours per day

1. Position Summary
The Billing/Insurance Coordinator is responsible for the full insurance billing cycle for the practice, including answering incoming phone calls, submitting and tracking insurance claims, and managing patient accounts receivable (A/R). This role requires active tracing and follow-up on insurance claims and patient A/R to keep accounts current and minimize outstanding balances.

Key responsibilities include:
• Answer incoming phone calls and assist patients with account/billing questions.
• Bill insurance claims and manage patient A/R; trace and follow up on outstanding claims.
• Enroll the practice in EFT (electronic funds transfer) with Delta Dental, Aetna, MetLife, and any other carrier that allows direct EFT without a third-party intermediary.
• Communicate with patients regarding balance inquiries.
• Follow up with eClaims/eServices to ensure efficient claim flow.
• Post insurance payments (checks and EOBs) received by mail, daily.
• Appeal denied claims.
• Generate and review the day sheet daily.
• Review clinical notes daily to support accurate billing and documentation.

2. Daily Duties & Tasks
Tasks are listed in no specific priority order.

# Daily Duty / Task Frequency Est. Time
1 Appeal Denied Claims Daily 1–3 hrs
2 Post Delta payments Weekly 4–5 hrs
3 Post insurance payments (all carriers) Daily 1–4 hrs
4 Bill daily insurance claims Daily 1–4 hrs
5 Day sheets Daily 1 hr up to a full day
6 Clinical notes review Daily Up to 5 hrs (improving)
7 Trace all outstanding claims 1–2 days/week As needed
8 EFT enrollment / eServices maintenance Weekly 1 hr
9 Check mail / drop off mail Daily 10 min
10 Patient A/R (calls, balance follow-up) Daily Varies — depends on time allotted

3. Roles & Responsibilities — Insurance Coordinator

The Insurance Coordinator is accountable for establishing, achieving, and maintaining the integrity of insurance claims within the practice. Depending on the accountability delegation between the Insurance and Treatment Coordinator, the Insurance Coordinator is responsible for submitting necessary insurance documentation to ensure insurance carriers make restitution quickly, overseeing practice collections, and maintaining minimum outstanding balances. The outcome is to maintain a “zero balance” office and all claims paid within 30 days in coordination with Treatment and Appointment Coordinators.
The following responsibilities fall under the scope of Insurance Coordinator:
Patient Investment Liaison

• Utilization of our practice management software (Dentrix) to generate information necessary for billing purposes for any patient with an outstanding balance.
• Manage all EOB's (post, review & follow up), correspondence and claims to and from insurance companies. Files appeals as necessary, which include narratives and electronic x-ray attachment.
• Post patient payments, deductibles and note progress for claim resubmittal if needed to primary or secondary insurance in patient ledgers. Ensure proper balancing of patient ledgers.
• Research refund requests and prepares requests for approval and maintains all credits reported and issued. Coordinate with treatment coordinators if needed.
• Generates aging reports for outstanding insurance claims and investigates all non-payments.
• Calls ALL patients with an outstanding balance and explains the balance to request for payment on account. This keeps an open line of communication and a sense of trust to patient. Send blanket statements approximately once a month.
Practice & Insurance Company Liaison
• Electronic claim submittal and maintenance.
• Be aware of problems in the practice management software and understand how the clearinghouse (eServices) system works for our claims.
• Communicate potential coding problems, trends, and insurance issues to the appropriate support (Treatment Coordinator or Dentist).
• Keep Usual and Customary Rates for practice location within the highest potential percentile (target: 85%).
• Research best PPO options and fees per insurance company for yearly review.

4. Equipment & Systems Used

System / Category Tool Used
Practice Management Software Dentrix
Analytics Dental Intel
Communication / Patient Texting Weave
Insurance Clearinghouse eServices / eClaims
Imaging / Other DEXIS

5. Special Skills & Certifications

No special licenses or certifications are required for this role. Practice management software experience with DEXIS is expected.