Insurance and Benefits Billing Specialist

POSITION SUMMARY The Insurance and Benefits Specialist facilitates the dental insurance prior authorizations, pre-treatment estimates, claim denials, appeals, and insurance follow-up to support timely reimbursement and efficient revenue-cycle operations.

This position works closely with clinical and administrative teams to ensure procedures are appropriately authorized, claims are submitted accurately, and denied or underpaid claims are resolved promptly and effectively.

KC CARE CULTURE CODE KC CARE follows a culture code in all we do.

Our code determines how we work, treat each other, and move health equity forward.

As an employee of KC CARE, you will: Put patients first, alwaysTreat all people with dignity, respect, and kindnessCreate safe places for others to share their voice; encourage creativityAlways strive for improvement; keep learningOwn your work, action, and mistakes no one is perfectHave fun work should be fun and we want you to have fun at KC CARE KC CARE CULTURE VALUES Exceptional Service:We value exceptional service in providing unconditional whole-person care to everyone with the promise of a personalized and affirming experience for patients.

We promise to treat internal and external partners with dignity, respect, and kindness to facilitate the opportunity for all to succeed.

Inclusion and Belonging: We value diversity, equity, inclusion, and belonging by focusing on differences that promote creativity and acceptance across the organization.

We promise to create a safe environment for individuality to flourish.

ESSENTIAL DUTIES AND RESPONSIBILITIES Verify dental insurance eligibility, benefits, limitations, exclusions, waiting periods, frequency limitations, and prior authorization requirements before treatment.Obtain, prepare, submit, and track dental insurance prior authorizations and pre-treatment estimates to support timely treatment planning and reimbursement.Review treatment plans, clinical notes, X-rays, periodontal charts, CDT procedure codes, and other supporting documentation to ensure authorization and claim requirements are met.Communicate with dental providers, clinical teams, administrative staff, and patients regarding insurance requirements, authorization status, treatment coverage, and anticipated patient responsibility.Monitor prior authorization and pre-treatment estimate status, ensuring timely follow-up with insurance carriers through phone, payer portals, and electronic correspondence.Review denied, rejected, and underpaid dental claims to identify denial reasons, payer requirements, coding issues, and opportunities for resolution.Research dental insurance policies, clinical guidelines, CDT codes, and payer-specific requirements to determine appropriate claim resolution strategies.Prepare and submit corrected claims, reconsiderations, and appeals with accurate clinical, coding, and insurance documentation.Interpret EOBs and ERAs to identify payment discrepancies, denial trends, bundling issues, frequenc...