How to Be Dental Insurance Specialist - Job Description, Skills, and Interview Questions

Sep 11, 2020 / 5 Minutes Read / By Albert

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The role of a Dental Insurance Specialist is to help individuals and families with their dental insurance needs. They are responsible for understanding the different policies, plans and coverage options offered by various dental insurance providers, and advising clients on the best plan for their individual needs. By helping clients choose the right plan, Dental Insurance Specialists can help them save money on dental care costs. Furthermore, by providing clients with information on preventive care, they can help reduce the need for expensive treatments in the future.

Steps How to Become

Obtain a High School Diploma or GED. Most employers require dental insurance specialists to have at least a high school diploma or equivalent.
Obtain a Bachelor's Degree. To become a dental insurance specialist, you will need to obtain a Bachelor's degree in a relevant field such as insurance, finance, or accounting.
Obtain Relevant Certification. Becoming certified in dental insurance is an important step in becoming a dental insurance specialist. The National Association of Dental Plans (NADP) offers the Certified Dental Insurance Specialist (CDIS) program which can help you further your knowledge in the field and increase your chances of being hired as a dental insurance specialist.
Acquire Work Experience. Many employers prefer to hire dental insurance specialists with at least two years of work experience in the industry. You can acquire this experience by interning or working in an entry-level position at a dental office or insurance company.
Complete Continuing Education. To maintain your certification and stay current with industry standards, you must complete continuing education courses regularly. The NADP offers several courses that can help you stay up-to-date on the latest regulations and practices in dental insurance.

Staying ahead and competent in the dental insurance specialist field requires a commitment to learning and continuous professional development. Keeping up with new industry standards, regulations, and technology can be a challenge, but it is essential for professionals to stay informed to ensure they are providing the best services to their clients. Additionally, attending seminars and conferences, networking with colleagues, and furthering education by obtaining certifications can help to increase knowledge and keep skills sharp. By staying informed, keeping up-to-date with changes in the industry, and advancing professional development, dental insurance specialists can stay ahead and remain competent in their field.

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Job Description

Determine eligibility for dental insurance coverage by reviewing applications and documents
Assist with filing dental insurance claims and coordinate reimbursement for services
Ensure that policies and procedures are adhered to comply with insurance regulations
Explain dental insurance benefits to patients and answer any questions
Resolve any insurance issues or discrepancies that arise
Monitor patient accounts for outstanding balances due to insurance companies
Generate reports and analyze data related to claims processing
Work with internal and external contacts to ensure timely payment of claims
Maintain up to date knowledge of insurance regulations and industry trends
Perform additional duties as needed

Skills and Competencies to Have

Knowledge of Dental Insurance Plans and Benefits
Ability to Explain Dental Insurance Terms to Patients
Proficiency in Verifying Dental Insurance Coverage
Expertise in Processing Insurance Claims
Experience in Working with Third-Party Payers
Skilled in Resolving Insurance Issues
Familiarity with Coding and Payment Regulations
Excellent Customer Service Skills
Proficiency in Computer Software Applications
Ability to Effectively Communicate with Dental Providers and Patients

Having a strong understanding of dental insurance is essential for any Dental Insurance Specialist. Without this understanding, it is difficult for specialists to accurately assess the needs of their clients and offer the best solutions. The specialist must have a comprehensive knowledge of dental insurance plans, including the various coverage options and current regulations.

They must be able to explain the different plans and help their clients understand what is covered and what is not. a Dental Insurance Specialist should have excellent communication skills, be organized and efficient, and have a good understanding of customer service. These skills are essential for the specialist to build relationships with their clients and ensure that the client gets the best possible outcome.

All of these skills together make a great Dental Insurance Specialist.

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Frequent Interview Questions

What experience do you have in dental insurance?
How do you stay up to date on changes in dental insurance regulations and industry trends?
How do you handle customer complaints or inquiries regarding dental insurance policies?
What methods have you used to educate customers about their dental insurance options?
How do you ensure accurate claims processing and payment?
How do you handle difficult customer requests or inquiries?
Describe your experience with dental insurance billing and coding.
How do you prioritize tasks when faced with multiple deadlines?
Describe a time when you had to troubleshoot a complex issue with a customer's dental insurance policy.
What do you consider to be the key elements of successful dental insurance customer service?

Common Tools in Industry

Electronic Medical Records (EMR) Software. A computerized system used to store patient information, track appointments, and generate reports. (e. g. Dentrix)
Practice Management Software. A software platform to manage patient information, scheduling, and billing. (e. g. Eaglesoft)
Insurance Verification Software. A tool used to verify insurance coverage and eligibility. (e. g. DentalXChange Dental Insurance Verification)
Claim Submission Software. A tool used to submit claims electronically to insurance providers. (e. g. DentalXChange ClaimConnect)
Claim Status Tracking Software. A tool used to track the status of submitted claims. (e. g. DentalXChange ClaimStatus)
Claims Analysis Software. A tool used to analyze claims data for trends or areas of improvement. (e. g. Athenahealth)
Online Benefits Calculator. A tool used to calculate patient co-pays, deductibles, and other benefits information. (e. g. DentalXChange Benefits Calculator)
Training and Education Platforms. A tool used to provide online training and education materials for dental insurance specialists and other staff members. (e. g. DentalXChange Academy)

Professional Organizations to Know

American Dental Association (ADA)
Academy of General Dentistry (AGD)
National Association of Dental Plans (NADP)
American Association of Dental Groups (AADG)
National Association of Insurance Commissioners (NAIC)
National Association of Professional Agents (NAPA)
American Society of Dental Insurance Administrators (ASDIA)
American Association of Dental Office Managers (AADOM)
American Institute of Certified Public Accountants (AICPA)
National Association of Health Underwriters (NAHU)

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Common Important Terms

Dental Coverage. A type of medical insurance specifically designed to cover the cost of dental care, such as routine check-ups, cleanings, x-rays, and treatments.
Pre-authorization. The process of obtaining permission from an insurance company before receiving certain services or treatments.
Out-of-pocket Expense. Money that must be paid by an individual for medical care, not covered by insurance.
Deductible. The amount of money that must be paid by an individual before the insurance company will begin to cover the cost of care.
Co-payment. A fixed fee an individual must pay when receiving a service or treatment covered by insurance.
Maximum Annual Benefit. The maximum amount an insurance company will pay for a given year for all services or treatments covered by the policy.
Capitation. A payment system in which a set fee is paid to a dentist or healthcare provider for each patient they provide services to, regardless of the number of services they actually provide.
Exclusions. Services or treatments that are not covered by an insurance policy.

Frequently Asked Questions

What is a Dental Insurance Specialist?

A Dental Insurance Specialist is someone who is trained to provide advice and assistance to individuals and businesses with dental insurance plans. They help to find the best coverage for their clients, advise on policy details, and manage claims and reimbursements.

What qualifications are required to become a Dental Insurance Specialist?

To become a Dental Insurance Specialist, most states require that a person has at least a high school diploma or equivalent and has completed a licensing exam, such as the American Association of Dental Insurance Specialists (AADIS) examination.

What are some of the responsibilities of a Dental Insurance Specialist?

A Dental Insurance Specialist is responsible for helping their clients understand their dental insurance plans and helping them choose coverage that best meets their needs. They also process claims and manage reimbursements, as well as handle customer service issues.

What type of training do Dental Insurance Specialists need?

Dental Insurance Specialists typically receive training in insurance policies, regulations, and claim processing. They may also receive additional training in customer service, conflict resolution, and problem-solving.