Job Title: Insurance Verification Specialist – Orthodontics (U.S. Dental Insurance)
Location: Remote
Job Type: Full-Time
Work Hours: Mon-Fri US EST Time
Position Summary
We are seeking a detail-oriented and experienced Insurance Verification Specialist to join our orthodontic practice. The ideal candidate will be responsible for verifying orthodontic insurance benefits, obtaining prior authorizations when required, and ensuring accurate insurance information is available before patient appointments. This role is essential in helping patients understand their orthodontic benefits while minimizing claim denials and improving revenue cycle efficiency.
Key Responsibilities:
- Verify patient eligibility and active insurance coverage before scheduled appointments.
- Contact insurance companies via phone and online payer portals.
Verify orthodontic benefits including:
o Lifetime orthodontic maximums
o Remaining orthodontic benefits
o Deductibles
o Coinsurance percentages
o Waiting periods
o Age limitations
o Frequency limitations
o Annual maximums (when applicable)
- Determine whether prior authorization or referrals are required.
- Verify PPO, DHMO, Medicaid, and other commercial insurance plans.
- Accurately document benefit information in the practice management software.
- Review treatment plans and provide estimated patient financial responsibility.
- Communicate insurance verification results to Financial Coordinators and Treatment Coordinators.
- Resolve insurance discrepancies before patient visits.
- Maintain HIPAA compliance and protect confidential patient information.
- Follow up with insurance carriers regarding missing or incomplete information.
- Support claim submission by ensuring accurate insurance data.
- Maintain detailed documentation of all insurance verification activities.
Required Qualifications:
- High School Diploma or GED.
- Minimum 2 years of U.S. dental or orthodontic insurance verification experience.
- Strong understanding of:
o PPO Dental Plans
o DHMO Plans
o Orthodontic Benefits
o Coordination of Benefits (COB)
o Insurance Eligibility Verification
- Excellent verbal and written English communication skills.
- Strong attention to detail and organizational skills.
- Ability to work independently while meeting daily productivity goals.
- Proficiency with Microsoft Office (Word, Excel, Outlook).
Preferred Qualifications:
Experience with one or more of the following:
- Cloud 9 Orthodontic Software
- Ortho2 Edge
- Dolphin Management
- Open Dental
Experience using insurance portals such as:
- DentalXChange
- Zelis
- Availity
- Payer web portals
Knowledge of CDT codes and orthodontic billing is preferred.
Skills
- Insurance Eligibility Verification
- Orthodontic Benefit Analysis
- Dental Insurance Knowledge
- Data Entry Accuracy
- Customer Service
- Telephone Communication
- Time Management
- Problem Solving
- Multi-tasking
- HIPAA Compliance
Performance Expectations (KPIs)
- Verify all scheduled patients before appointments.
- Maintain 98%+ verification accuracy.
- Complete insurance verification within established turnaround times.
- Reduce claim denials caused by eligibility or benefit errors.
- Maintain accurate documentation for every patient account.
- Meet daily productivity and quality targets.
Work Location: Hybrid remote in Hyderabad, Telangana (Hyderabad District)
