Insurance Operations Coordinator

PAT BILLER 4 (004662)

UCPath Position ID: 40093594

Position Description History/Status

For Reference ONLY - PeopleAdmin JA Number:

601633

Approved Date:

3/14/2025 4:52:22 PM

Date Last Edited:

3/14/2025 4:52:19 PM

Last Action Effective Date:

3/13/2024

Organization Details

Business Unit (Location):

LACMP

Organization Code:

2100O

Organization:

DENTISTRY

Division Code:

2110D

Division:

CLINICAL

Department:

135000 - DENTISTRY

Position Details

UCPath Position Number:

40093594

Position Description ID

169749

UC Payroll Title:

PAT BILLER 4 (004662)

Business Title:

Insurance Operations Coordinator

Personnel Program

Professional and Support Staff (PSS)

Salary Grade:

STEPS

Job Code FLSA:

Non-Exempt

Union Code (Collective Bargaining Unit):

EX: Patient Care Technical

Employee Relations Code:

E: All Others - Not Confidential

Employee Class (Appt Type):

2 - Staff: Career

Full-Time Equivalent (FTE)

1

SUPERVISION

UCPath Reports to Position Number:

40063722

Reports to Payroll Title:

AMBUL CARE ADMSTN SUPV 2

UCPath Department Head Position Number:

40061708

Department Head Payroll Title:

DEAN

GENERAL SUPERVISION - Indicates that the incumbent develops procedures for performance of variety of duties; or performs complex duties within established policy guidelines.

POSITION SUMMARY

The Insurance Operations Coordinator plays a key role in the Faculty Group Dental Practice, which includes over 25 general dentists and specialists. This position is responsible for three primary functions:

Insurance Management – Oversees the billing of dental claims, audits patient accounts, and processes claim resubmissions for denials or errors. Ensures that overpayments by patients or insurance companies are identified and reported to the Practice Manager and Practice Director for timely reimbursement.

Patient Counseling – Acts as the primary point of contact in the Faculty Group Dental Practice for practitioner and patient inquiries regarding insurance coverage, benefits, and claims.

Office Support – Provides backup support as needed and assists with additional tasks assigned by the Practice Manager.

This role requires strong attention to detail, excellent communication skills, and the ability to effectively manage insurance-related processes within a fast-paced dental practice.

Aspiring to be a community of faculty, staff, students and patients, where a sense of belonging and respect is felt by all, is a culture that’s deeply ingrained into our daily actions. And encouraging an environment of engagement and productive dialogue helps to foster our core values of compassion, tolerance, and mutual respect.

INSURANCE MANAGEMENT

1. Responsible for billing of all dental claims to all insurance companies for more than 25 faculty and contract dentists, including specialties.    

2. As part of billing process, gather and document appropriate patient treatment notes and radiographs in order to submit claims by paper or electronic as appropriate and ensure that the claim is processed appropriately by the insurance company.    

3. Audit patient accounts for which there are explanation of benefits on a daily basis to determine if the claims have been processed and paid correctly by the insurance company.    

4. For claims that have been processed incorrectly or denied in error, review original submission and correct and supplement information as appropriate for re-processing by the insurance companies.    

5. For patient accounts that have been overpaid by the insurance companies or the patients, prepare support documentation for refund approval by the Practice Manager and Practice Director (in accordance with University processes).  

6.  As necessary/appropriate, communicate directly with insurance companies and/or patients regarding outstanding claims and/or insurance benefits. Routinely monitor and follow up on insurance companies' accounts receivable.    

7. In the event that the authorized amount is less than expected due to a contractual allowance, prepare support documentation for the Practice Manager so that the appropriate adjustment to the patient's account in accordance with university and contractual obligations.     

8. For unique situations (and/or by patient request) submit pre-authorization requests to the insurance companies for various procedures.    

9. Routinely update the Trojan insurance program on a weekly basis to ensure that the most updated information regarding insurance benefits is in the database used for billing and accounts receivable management.

70%

PATIENT COUNSELING

1. Serve as the primary contact in the Faculty Group Dental Practice for practitioners and patient inquiries regarding insurance coverage, benefits and claims.    

2. Format and correct patient treatment plans to accurately reflect the expected insurance coverage and reimbursement. Review with new and returning patients while addressing any questions.

20%

OTHER DUTIES

1. Ensure proper data entry and management of patient information within the system.

2. Provide backup support for office tasks including but not limited to receptionist and administrative assistant.    

3. Perform additional responsibilities as assigned by the Practice Manager.

10%

•

Performs other duties as assigned.

•

Complies with all policies and standards.

•

Complies with the University of California, Los Angeles (UCLA) Principles of Community.

•

This position description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of the organization.

QUALIFICATIONS

Knowledge of dental terminology and dental procedures for general dentistry and all specialties.

Required

Demonstrated data entry skills to enter accurate patient and insurance information and payments.

Required

Skill in effectively communicating with patients, co-workers and faculty.

Required

Ability to adapt to frequent interruptions and changes in work assignments and to prioritize work in a complex, high-volume, fast-paced environment.

Required

Ability to interact with people in a way that reflects the customer-focused approach of the practice.

Required

Demonstrated skill in analyzing information, situations and procedures to define problems, formulate and appropriately rectify concerns.

Required

Demonstrated knowledge of what constitutes confidential information and skill in maintaining confidentiality with regard to patient, faculty and staff information.

Required

Ability to organize work and determine priorities.

Required

SPECIAL REQUIREMENTS AND/OR CONDITIONS OF EMPLOYMENT

Background Check: Continued employment is contingent upon the completion of a satisfactory background investigation.

Live Scan Background Check: A Live Scan background check must be completed prior to the start of employment.

Age Requirement: Candidate(s) must be 18 years or older to be eligible to be hired.

TB Test: Continued employment is contingent upon the completion of a satisfactory TB test.

COVID and Flu Vaccinations: The position is subject to providing evidence of inoculation.

CANRA: The position is designated as a mandatory reporter under CANRA. The employee must sign the "Statement Acknowledging Requirement to Report Child Abuse".

LOCATION AND PHYSICAL, ENVIRONMENTAL, MENTAL (PEM) REQUIREMENTS

Environment and Work Location Information

Environment Type:

Clinical Setting

Location Setting:

Campus

Location:

School of Dentistry

Standing/Walking

X

Sitting

X

X

Bending/Stooping

X

Squatting/Kneeling

X

Climbing

X

Lifting/Carrying/Push/Pull 0-25 lbs

X

X

Lifting/Carrying/Push/Pull 26-50 lbs

X

Lifting/Carrying/Push/Pull over 50 lbs

X

Physical requirements other

X

Chemicals, dust, gases, or fumes

X

Loud noise levels

X

Marked changes in humidity or temperature

X

Microwave/Radiation

X

Operating motor vehicles and/or equipment

X

Exposures other

X

Sustained attention and concentration

X

X

Complex problem solving/reasoning

X

X

Ability to organize & prioritize

X

X

Communication skills

X

X

Numerical skills

X

X

Mental demands other

X

X

Classification 3:  Position in which exposure to blood, body fluids or tissues is not part of the position description. The normal routine task involves no exposure to blood, body fluids or tissues and the employee can decline to perform tasks which involve a perceived risk without retribution.