Insurance Services Manager

Location: Stockton

Overview
Primary Purpose  Under the general supervision of the Director of Patient Financial & Revenue Cycle ( DPFRC ), this role manages the business activities of the main clinic and designated clinic programs, and supervises the insurance processing team to support patient access, claims management, reimbursement, and collections functions of the department. Responsibilities include monitoring and managing staff adherence to national and payer-specific claims processing regulations and ensuring accurate, timely, and complete processing of insurance claims and posting of payments in compliance with university protocols.

University of the Pacific recognizes that diversity, equity, and inclusion are foundational to the success of our students and employees. We prioritize policy and decision-making that demonstrates awareness of, and responsiveness to, the ways socio-cultural forces related to race, gender, ability, sexuality, socio-economic status, etc., impede or propel students, faculty, and staff.

Essential Functions

Manage and support operations related to the evaluation, processing, and handling of claims; ensure departmental, federal, and state standards are maintained and that claims are handled accurately and timely.

Plan future courses of action and management of the overall insurance/posting activities to ensure effective and efficient operations.

Maintain up-to-date all insurance setup information in Axi Um and Dolphin applications, including but not limited to insurance companies, benefit plans, coverage templates, contract plans, and billing provider information.

Ensure accurate posting of all charges and patient payments daily; review/advise on accuracy and completeness of procedure codes, fee schedules, and treatment notes.

Review, monitor, and analyze claim activity reports for the Revenue Cycle staff, including claim submission, production, billing, and accounts receivable; ensure insurance billers monitor and manage claim productivity.

Reconcile and resolve financial issues with patients and resolve insurance grievances between insurance companies and patients.

In collaboration with the DPFRC, develop and manage business policies and procedures for clinic operations; provide the Business Office with reports and reconciliations as necessary.

In collaboration with the DPFRC, manage all contracts and communications with Delta and other approved contract providers; ensure timely annual filing of fees; create and maintain current documentation regarding policies for processing, billing, and collecting insurance.

Set daily expectations; monitor performance to ensure staff meet or exceed established performance goals (production and quality).

Oversee and manage clinic finance liaison, group practice patient care, and insurance coordinators as part of the financial team to optimize revenue capture through best practices and technology/resource efficiency.

Support the DPFRC and Clinical Financial Operations Manager to train students, faculty, and staff on proper protocols and procedures related to insurance.

Act as a liaison between the School of Dentistry, insurance providers, and patients regarding status and eligibility for coverage; manage and resolve patient billing inquiries.

Provide monthly summary reports to the Business Office; review clinic production and expenses; advise and make recommendations to ensure achievement of budget goals.

Actively seek process improvements, automation, and cost-efficient initiatives related to clinic business activities.

Perform all other duties as assigned by the Director of Patient Financial & Revenue Cycle.

Minimum Qualifications

Knowledge of: dental practice management; dental/medical insurance credentialing; and related healthcare revenue cycle concepts (billing, collections, charge capture, contractual adjustments, third-party reimbursements, cash management).

Proven ability to manage time effectively, balance multiple priorities, and drive tasks to successful completion; navigate complex/urgent issues with clarity and efficiency.

Electronic dental billing systems; accounting/billing procedures; principles of management and supervision; business…