How to Be Orthodontics Insurance Coordinator - Job Description, Skills, and Interview Questions

Jun 5, 2020 / 5 Minutes Read / By Albert

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The role of an orthodontics insurance coordinator is crucial in the dental healthcare industry. They are responsible for obtaining insurance coverage for orthodontic services and ensuring that the patient is aware of their coverage. This is important for financial planning for the patient, as it allows them to budget for their dental care without unexpected financial surprises.

The orthodontics insurance coordinator must also be knowledgeable about the different types of insurance coverage available to the patient, as well as any policies and regulations that may affect the patients coverage. Furthermore, they must constantly update their knowledge of changes to the insurance industry in order to ensure that patients receive the coverage they need. By providing these services, the orthodontics insurance coordinator helps ensure that patients get the best care possible.

Steps How to Become

Obtain a high school diploma or equivalent. Most employers require at least a high school diploma or GED to become an orthodontics insurance coordinator.
Get a degree in a related field. Many employers prefer to hire individuals with at least an associates degree in a health care-related field, such as dental hygiene, medical billing, or medical insurance.
Consider taking a certificate program. There are a variety of certificate programs available to help individuals gain the knowledge and skills necessary to become an orthodontics insurance coordinator. These programs typically take one year or less to complete.
Gain experience in the field. Most employers prefer to hire individuals with at least one year of experience in a dental office or other medical setting.
Obtain certification. Certification is not required to become an orthodontics insurance coordinator, but it can help demonstrate an individuals knowledge and expertise in the field. To become certified, individuals must typically pass an exam administered by a professional organization.
Acquire additional certifications. Acquiring additional certifications, such as those related to coding and billing, may help increase an individuals job prospects.
Maintain certification and stay up to date on industry trends. Orthodontics insurance coordinators must stay abreast of changes in the industry to ensure that they are providing accurate and up-to-date information to their patients.

The importance of an Orthodontics Insurance Coordinator is to ensure that patients receive their insurance benefits for orthodontic treatments. An experienced Orthodontics Insurance Coordinator must be skilled and efficient in order to effectively manage the process and paperwork. They must possess knowledge in insurance policies and procedures, as well as the ability to communicate effectively with patients and insurance companies.

An Orthodontics Insurance Coordinator should have the ability to maintain accurate records, review insurance claims and ensure that claims are processed in a timely manner. they must have the ability to explain insurance policies to patients and help them understand their coverage. An Orthodontics Insurance Coordinator that is skilled and efficient can provide a great service to both the patient and the orthodontic office.

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Job Description

Develop and maintain relationships with insurance companies to ensure accurate and timely payment of orthodontic claims.
Create, process and track insurance claims for orthodontic services.
Monitor orthodontic accounts receivables and follow up on overdue payments.
Analyze reimbursement trends and identify opportunities to increase reimbursement.
Resolve patient inquiries related to insurance coverage and reimbursement.
Educate patients and staff on insurance coverage and reimbursement policies.
Review insurance plans for coverage eligibility and recommended treatments.
Monitor changes in insurance policies and update office procedures accordingly.
Negotiate fee schedules with insurance companies.
Maintain accurate records of insurance claims, payments and adjustments.

Skills and Competencies to Have

Working knowledge of dental coding and insurance reimbursement systems and procedures.
Familiarity with private and public insurance plans and policies.
Ability to explain insurance coverage and benefits to patients.
Strong organizational and time management skills.
Excellent communication, interpersonal, and customer service skills.
Ability to multi-task and prioritize tasks efficiently.
Detail-oriented with accuracy in data entry and paperwork processing.
Proficiency with computers and dental software programs.
Ability to stay calm and composed under pressure.
Ability to effectively resolve insurance disputes and claims.

Effective communication is essential for an orthodontics insurance coordinator. They must be able to effectively communicate with insurance companies, patients, and other healthcare providers in order to ensure the accuracy and timeliness of claims. They must also be able to understand and interpret insurance policies, and be able to effectively explain them to patients.

If a coordinator is not well-versed in the intricacies of insurance policies and how they translate into practical applications, they may not be able to accurately coordinate insurance claims. This can lead to delays in payments and claims denials, resulting in fewer successful orthodontic treatments and frustrated patients. Good organizational skills are also important for a successful orthodontics insurance coordinator.

They must be able to keep track of insurance claims, deadlines, and any changes that may occur. This requires the ability to pay attention to details and maintain accurate records. It is also important for orthodontics insurance coordinators to have a strong customer service mentality in order to effectively interact with patients and ensure their satisfaction with their treatment.

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Frequent Interview Questions

What experience do you have in the field of orthodontics insurance?
How familiar are you with insurance policies, contracts, and procedures?
Describe a time when you had to work with a difficult insurance provider.
How do you stay up-to-date on changes in the insurance industry?
Describe a time when you had to explain complex insurance policies to patients.
What challenges have you faced in coordinating patient payments for orthodontic treatments?
How do you handle discrepancies between patient bills and insurance claims?
What methods do you use to ensure accurate data entry of patient information?
How do you handle difficult conversations with insurance companies?
What sets you apart from other orthodontics insurance coordinators?

Common Tools in Industry

Medical Billing Software. Software that automates medical billing processes and creates electronic claims to submit to insurers. (eg: Kareo)
Electronic Patient Records (EPR). Software that digitally stores patient records and clinical data to enable easy access and sharing of information between healthcare providers. (eg: Epic)
Dental Management Software. Software that enables dental practices to manage their billing, scheduling, patient records, and more. (eg: Dentrix)
Claims Processing System. Software that automates the claims process, including verifying coverage and calculating reimbursement. (eg: Change Healthcare)
Insurance Verification Software. Software that verifies insurance coverage and eligibility to ensure patients are not overcharged. (eg: QNXT)
Patient Scheduling Software. Software that automates appointment scheduling and provides alerts for upcoming appointments. (eg: Athenahealth)

Professional Organizations to Know

American Association of Orthodontists (AAO)
American Board of Orthodontics (ABO)
American Dental Association (ADA)
American College of Prosthodontists (ACP)
International Association for Dental Research (IADR)
American Academy of Pediatric Dentistry (AAPD)
National Institute of Dental and Craniofacial Research (NIDCR)
American Cleft Palate-Craniofacial Association (ACPA)
World Federation of Orthodontists (WFO)
World Health Organization (WHO)

We also have Special Needs Dental Assistant, Orthodontic Clinical Supervisor, and Denturist jobs reports.

Common Important Terms

Pre-Authorization. A process of obtaining prior approval from an insurance company for a specific medical treatment or procedure.
Deductible. An amount paid out of pocket by the insured before the insurance company begins to pay for medical services.
Copayment. A fixed amount paid by the insured for a medical service, usually at the time of service.
Coinsurance. A cost sharing arrangement between the insured and the insurance company, which requires the insured to pay a percentage of the total bill for a medical service.
Reimbursement. Money paid by an insurance company to an insured for medical expenses after the bill has been paid.
Coverage Limits. The maximum amount of money an insurance company will pay for a given service.
Exclusions. Specific services, treatments, or products that are not covered by an insurance plan.
Covered Services. Services, treatments, or products that are covered by an insurance plan.
Claim Form. A form that must be completed by the insured and submitted to the insurance company in order to receive reimbursement for medical expenses.
Provider Network. A group of health care providers that have contracted with an insurance company to provide services at discounted rates.

Frequently Asked Questions

Q1: What is an Orthodontics Insurance Coordinator? A1: An Orthodontics Insurance Coordinator is a professional who is responsible for managing patient insurance plans, filing claims, and coordinating benefits with insurance companies. Q2: What duties are typically performed by an Orthodontics Insurance Coordinator? A2: The duties of an Orthodontics Insurance Coordinator include verifying patient eligibility and benefits, submitting claims, tracking payments, and resolving any discrepancies with insurance companies. Q3: How many years of experience are needed for a successful Orthodontics Insurance Coordinator? A3: Most Orthodontics Insurance Coordinators should have at least two years of experience in the dental field. Q4: What types of software are used by Orthodontics Insurance Coordinators? A4: Orthodontics Insurance Coordinators typically use software such as Dentrix and Eaglesoft to process insurance claims and track payments. Q5: What type of degree is required to become an Orthodontics Insurance Coordinator? A5: Typically, an Orthodontics Insurance Coordinator should have a degree in a related field such as healthcare administration, finance, or accounting.