The Dental Eligibility Specialist is responsible for obtaining, interpreting, and accurately documenting comprehensive dental insurance eligibility and benefit information within Epic. This job uses payer portals, electronic eligibility resources, and direct telephone contact with insurance carriers to obtain complete breakdowns of benefits that support accurate treatment planning, patient financial estimates, front-office discussions, and accurate billing and claims processing. This job requires strong dental insurance knowledge, including dental terminology, CDT procedure codes, coverage levels, frequencies, annual maximums, deductibles, limitations, exclusions, and treatment history requirements. The Dental Eligibility Specialist must recognize when information available electronically is incomplete, conflicting, or unclear and take the necessary steps to obtain accurate information.
