Receives, learns to or performs review of dental claims for payment for benefits, checking for completeness and returning claims for additional information as appropriate

Learns to verify or verifies patient eligibility for coverage of claims received, checking appropriate records for birth date, social security number, date of eligibility, and type of coverage

Learns to analyze or analyzes claims for possible discrepancies including duplication of services, duplication of billing, and incorrect procedure identification, recommending consultant review of claims as appropriate

Learns to identify or identifies applicable primary insurance carriers for claims received and coordinates payment of benefits with primary carriers

Learns to calculate or calculates amounts payable for claims received, according to established guidelines; enters payment amounts into accounts payable records; and submits to appropriate authorities for approval

Learns to prepare or prepares specific claims for pre-authorization requests for consultant review, preparing files and indicating policy limitations related to procedures being reviewed

Dental Claims Insurance Assistant/Dental Claims Insurance Examiner

(Alternate Class Series)

Learns to process or processes pre-authorization requests, indicating consultant's decision, calculating amount to be paid, and returning request to dentist office

Learns to calculate or calculates premium costs for participating school districts, auditing school district enrollment adjustments and adjusting premium as appropriate

Learns to process and monitor or processes and monitors enrollment forms of new employees and verifies eligibility and dependent information

Provides information regarding status of claims, dental plan benefits, and clarification of consultant's review to staff, employees, school districts, insurance companies, and dental offices

Obtains information related to coordination of benefits, dental treatments, fees charged, and clarification of claims from staff, employees, school districts, insurance companies, and dental offices

Maintains accurate reports and prepares reports related to dental plan enrollment and dental claims received, paid, pending, and in-process

Learns to process and monitor or processes and monitors accounts payable and receivable related to dental claims, making accurate postings to financial ledgers

Learns to or perform auditing of claims reimbursements, maintaining audit trails and ensuring proper fiscal controls

Learns to operate or operates internal accounting information systems, microcomputer hardware and software including spreadsheet and word processing programs

Serves as an information source or intermediary regarding dental insurance and dental claims

Performs related duties as assigned.

Basic knowledge of dental procedures and terminology

Establishment and maintenance of records and files

Modern office methods, practices, and procedures

Dental procedures and terminology

Dental insurance program policies and procedures, and claims processing

Basic knowledge of California Dental Association policies and State Department of Insurance laws, regulations, rules, and policies applicable to the establishment and processing of claims

Standard office equipment including microcomputer, typewriter, calculator, copier, and fax machine

Proper English usage including grammar, punctuation, spelling, and sentence structure

Perform a variety of dental claims analysis, processing, and reimbursement functions

Gather, organize, analyze, and present a variety of data related to dental claims establishment and processing

Interpret and apply laws, rules, regulations, and guidelines applicable to the establishment of employee eligibility and dental insurance claims establishment and processing

Understand complex dental procedures and terminology

Maintain accurate records and prepare reports related to dental claims processing and dental plan enrollment

Communicate effectively in oral and written form

Identify problem areas or situations, determine problem causes, and take appropriate action to resolve identified problems

Make arithmetical calculations quickly and accurately and identify and correct errors in arithmetical calculations made by others

Operate standard office equipment and machines including microcomputer, typewriter, copier, fax machine, and calculator

Effectively represent the County Office of Education in working with internal/external customers

Establish and maintain effective work relationships with those contacted in the course of assigned duties.

Dental Insurance Claims Assistant: Generally, the required knowledge, skills, and abilities will have been acquired through some office skills training or previous experience performing general clerical/office support functions.

Dental Insurance Claims Examiner: Generally, the required knowledge, skills, and abilities will have been acquired through two years of previous experience establishing and processing of dental claims or similar insurance claims comparable to that of a Dental Insurance Claims Assistant.