Insurance and billing are cornerstones of any dental practice’s financial health. Traditionally, one team member has been responsible for filing claims, tracking payments, and addressing denials. But the landscape has changed.
Insurance has grown increasingly complex, requiring expertise in coding, compliance, payer regulations, and patient communication. This is no longer just an administrative function; it is highly specialized. While someone can be trained, the bigger questions are: do they have the aptitude, and are you willing to invest the training time? If the answer is “no” to either, outsourcing to a vetted company may be the most efficient solution. Having the wrong person in this role significantly affects your revenue with practices losing around 5-10% of their revenue. (1)
For practices keeping insurance and billing in-house, it may be time to rethink the role. Instead of relying on one overwhelmed individual, consider creating a two-person team.
Why Two Roles Instead of One?
When one person carries full responsibility, the practice is vulnerable to delays if that team member is absent, overloaded, or undertrained. Splitting responsibilities into two complementary positions creates accountability and continuity.
In my own practice, establishing dual roles significantly increased revenue, improved efficiency, and provided added administrative support for the team. These roles became essential drivers of the practice’s financial success.
The Billing and Insurance Manager (or Supervisor)
The Billing and Insurance Manager serves as overseer and strategist. They ensure claims are submitted on time, denials are tracked, and follow-up procedures are consistent. They maintain current knowledge of payer requirements and compliance changes, while training both the specialist and broader team on documentation and insurance protocols.
Financially, the manager works with patients to establish payment agreements, oversees accounts receivable, and monitors collections. They prepare monthly reports to identify trends and red flags for leadership, and they serve as the primary contact for escalated billing issues. This role requires both business acumen and clinical understanding, as well as the leadership skills to manage systems and people.
The Billing and Insurance Specialist
The Billing and Insurance Specialist handles the daily execution that keeps revenue flowing. They submit claims, post payments, follow up on outstanding claims or denials, and prepare patient statements. They also explain financial options, conduct collection calls, and support the manager in overseeing accounts receivable.
Working closely with the manager, the specialist helps train other team members on insurance requirements and documentation standards. This position demands meticulous attention to detail, persistence, and strong communication skills.
Daily Claim Scrubbing and Collaboration
A critical function of both roles is daily claim scrubbing: a proactive process ensuring every claim leaves the office clean and complete. This includes real-time chart audits, reviewing clinical notes, verifying coding accuracy, and confirming that all supporting documentation (films, attachments, etc.) is included. The goal is simple but powerful: documentation that tells a complete story, justifies treatment, and expedites payment. By catching errors before submission, the team reduces denials, shortens turnaround times, and protects the practice from costly revenue leaks.
The manager and specialist also collaborate with the clinical team daily to clarify documentation and resolve coding questions. In team meetings, they present key metrics such as outstanding claims, denial trends, and collection percentages, giving everyone visibility into the practice’s financial health. This rhythm of auditing, collaborating, and reporting builds a culture of accuracy, accountability, and shared responsibility.
Beyond Dollars: Patient Experience and Risk
Insurance and billing are not just about revenue—they directly affect the patient experience. Clear, compassionate financial communication builds trust, while confusing or delayed statements erode it.
These roles also safeguard compliance. Errors in documentation or coding can trigger audits, fines, and lost revenue. Having two defined roles creates checks and balances that protect both the practice and its patients.
Considerations for Solo Practices
In larger practices, two dedicated roles are ideal. But in solo practices, team members already juggle multiple hats, and insurance and billing often fall on the office manager. The reality is that this work is a full-time job requiring focus and minimal distractions.
For solo practices, outsourcing is often the most efficient solution. A reputable billing company provides the specialized attention needed while freeing the office manager to focus on broader operations, patient care, and team leadership.
Looking Ahead: The Future of Billing
Technology is reshaping the landscape. Cloud-based systems, AI-driven claim scrubbing, and virtual billing assistants streamline processes and reduce errors. Yet human oversight remains essential. Technology can boost efficiency, but only trained professionals ensure compliance, accuracy, and patient-centered communication.
Final Thoughts
Insurance and billing are not “back office” tasks—they are vital to your practice’s health and reputation. Treating these responsibilities as a two-person system not only protects revenue but also elevates culture and patient satisfaction.
In today’s environment, complexity isn’t going away. With the right structure—whether outsourcing, splitting into two roles, or a hybrid approach—you can keep your revenue cycle strong, stable, and future-ready.
The question remains: Is your billing system fueling growth, or quietly draining your practice’s potential?
References:
