Job Description

Overview

The Insurance Audit Manager will oversee and manage the insurance billing, claims-audit, and compliance functions for the dental practice/group. They will develop audit policies/procedures, lead reviews of insurance claim submission and payment reconciliations, identify risks of overbilling / under-billing / coding inaccuracies, provide guidance to front-office, billing and treatment-coordination teams, and ensure the practice remains compliant with third-party payor/insurer requirements and regulatory standards.

Key Responsibilities

Develop, implement, and maintain a risk-based audit program for insurance claims (both patient-benefit insurers and third-party payors) specific to dental procedures: coding accuracy, predeterminations, documentation supporting treatment, patient eligibility. Lead regular audits of submitted claims: review claim codes vs treatments performed, verify pre-authorizations, flag exceptions, identify patterns of denials or write-offs. Monitor accounts receivable and payer payment trends, identify anomaly or risk (e.g., unusually high denial rates, large write-offs, missing documentation). Work closely with billing/claims team, treatment coordinators, and clinical staff to ensure proper documentation, predeterminations, correct coding (e.g., per provincial dental fee guide or insurer schedule), and efficient claim submission. Provide training and support to clinic staff on insurance billing best-practices, claim submission, appeals, denials management, predetermination workflows, and audit-preparedness. Maintain and update standard operating procedures (SOPs) relating to insurance billing, audits, documentation requirements, appeals processes, and internal controls. Liaise with external insurers, benefit administrators and third-party payors to clarify claim issues, respond to audit queries, and implement improvements. Prepare and present audit-findings, key metrics (e.g., denial rate, days in AR, write-off ratio, correction-rate) to senior management/owners; recommend corrective action and monitor remediation. Ensure compliance with regulatory requirements, provincial dental associations, patient-privacy legislation, and insurer requirements. Manage, mentor and supervise any audit/claims-review staff, set goals and track performance. Potentially participate in selecting/implementing practice-management or billing software enhancements, analytics tools for claim monitoring. Maintain awareness of changes in dental insurance policy/benefit design, insurer guidelines, predetermination requirements, and adjust audit program as needed.
Qualifications & Skills

Bachelor's degree in business, health administration, accounting, or related - or equivalent relevant experience. Several years (e.g., 5-10) of experience in dental office billing/claims or insurance administration within dental or health-care setting. Strong knowledge of dental insurance processes, predeterminations, claim submission, denial/appeal processes, and dental coding/fee-guide familiarity. Audit, compliance or internal-controls experience is a strong asset. Excellent analytical skills: ability to review data, identify trends/anomalies, recommend improvements. Strong communication and training skills: able to work cross-functionally with clinical, administrative and financial staff. Detail-oriented with strong organizational and time-management ability. Experience supervising and developing staff. Proficiency with practice-management software, MS Excel/spreadsheets, audit/analytics tools preferred.
Working Conditions

Full-time salaried position. Office-based in the dental clinic's head office or main site; may include occasional visits to satellite clinic locations (if multi-site). Reports to Practice Owner/General Manager/Director of Operations (depending on size). May require flexible hours during audit-cycles, month-end reviews or when claims issues escalate.
Key Performance Indicators (KPIs)

Reduction in insurance denial rate (percent of claims denied). Days in accounts receivable (AR) for insurance-claims. Ratio of write-offs due to claims issues / billing errors. Accuracy rate of claim submissions (audit-correction rate). Number of staff trained and compliance incidents identified and resolved. Documentation completeness (supporting treatment codes, predetermination, etc.). Audit-finding closure / remediation rate.
Salary commensurate with experience

Salary and benefits and positions based in NE Calgary

Relocation allowance and accommodation help for right candidate

Job Type: Full-time

Pay: $80,311.72-$157,844.47 per year

Work Location: In person