Pre-Billing Specialist – Dental Insurance

Description

Familia Dental is seeking a Pre-Billing Specialist with dental insurance experience to join its corporate support team. The primary responsibility of this position is the creation and maintenance of insurance plans within the Practice Management System (PMS), including the accurate assignment of fee schedules. Accurate plan setup supports correct patient estimates, clean claim submission, and proper reimbursement across all Familia Dental clinics.

The Pre-Billing Specialist will work closely with the Billing and Operations departments. As the specialist gains proficiency, the role will expand to include additional pre-billing, reimbursement, and credentialing responsibilities, for which comprehensive training will be provided.

• Create new insurance plans and employer profiles in the PMS for all Familia Dental clinics.
• Assign the appropriate fee schedule to each plan based on payor, network participation, and contract terms.
• Modify and update existing plans to reflect changes in coverage, fee schedules, or insurance type.
• Review insurance and carrier verifications to confirm the accuracy of plan data entered in the PMS.
• Support clinics in ensuring the correct plan and benefits are attached to patient accounts.
• Serve as a resource to clinic staff on plan setup and fee schedule assignments, and resolve related errors in a timely manner.

• Maintain reimbursement rates and fee schedules for assigned payors.
• Analyze underpayments and over payments, identify trends, and collaborate with the Billing department and payors to resolve discrepancies.
• Assist management with annual adjustments to the UCR (Usual, Customary, and Reasonable) Fee Schedule.
• Participate in contracted and non-contracted payor audits and report findings to the appropriate department.
• Research private and government payor rules and regulations specific to dental services.
• Support credentialing and payor enrollment for newly hired providers and maintain accurate enrollment records.
• Perform general office duties, including filing, answering telephones, and routine correspondence.
• Maintain compliance with HIPAA and all applicable regulatory requirements.
• Perform other duties as assigned.

• High school diploma or equivalent.
• Minimum of two (2) years of dental or healthcare insurance experience (e.g., insurance coordinator, insurance verification, billing, or claims).
• Demonstrated experience creating or maintaining insurance plans in a practice management or billing system.
• Working knowledge of fee schedules and their application to in-network and out-of-network plans.
• Proficiency with insurance carrier portals for plan, eligibility, and benefit information.
• Exceptional attention to detail and accuracy in data entry.
• Effective written and verbal communication skills.
• Knowledge of HIPAA regulations and a commitment to patient confidentiality.
• Proficiency in Microsoft Office (Word, Excel, Outlook).

• Experience with a dental practice management system, Denticon preferred.
• Experience with reimbursement analysis, payor audits, or UCR fee schedules.
• Experience with provider credentialing or payor enrollment.
• Experience in a multi-location dental practice or Dental Support Organization (DSO).

Familia Dental is a Dental Support Organization with 35 offices across five states and more than 100 dentists providing comprehensive dental services, from general dentistry to orthodontics.

• Competitive compensation
• Medical, dental, and vision insurance
• Paid time off, sick leave, and paid holidays
• 401(k) retirement plan
• Life insurance
• Hybrid work schedule
• Collaborative, team-oriented environment