PPO Plans
PPO Plans (Preferred Provider Organization Plans) are a common type of dental insurance arrangement that dental offices work with. They are insurance plans that give patients more flexibility in choosing their dentists compared to other plans. When a dental office accepts PPO plans, it means they have agreed to provide services at pre-negotiated rates with insurance companies. This is different from HMO plans, which are more restrictive. Dental offices can be "in-network" (meaning they've agreed to specific rates) or "out-of-network" (meaning they haven't). Most dental practices work with multiple PPO plans to attract more patients.
Examples in Resumes
Managed billing and insurance verification for 200+ patients with PPO Plans monthly
Increased practice revenue by 30% through efficient PPO claims processing
Trained staff on proper verification and billing procedures for PPO Plans and PPO networks
Typical job title: "Dental Insurance Coordinators"
Also try searching for:
Where to Find Dental Insurance Coordinators
Professional Networks
Job Boards
Example Interview Questions
Senior Level Questions
Q: How would you handle a situation where an insurance company consistently denies claims that should be covered under their PPO plan?
Expected Answer: A senior coordinator should explain the process of appealing claims, maintaining documentation, building relationships with insurance representatives, and training staff on proper submission procedures to prevent future denials.
Q: What strategies have you implemented to maximize PPO reimbursements?
Expected Answer: Should discuss reviewing fee schedules regularly, understanding different PPO contract terms, negotiating with insurance companies, and implementing systems to track and analyze reimbursement patterns.
Mid Level Questions
Q: How do you explain PPO benefits and limitations to patients?
Expected Answer: Should demonstrate ability to break down complex insurance terms into simple language, explain deductibles, co-pays, and annual maximums, and show experience in handling patient questions about coverage.
Q: What's your process for verifying PPO insurance benefits?
Expected Answer: Should outline steps for checking eligibility, confirming coverage levels, understanding waiting periods, and documenting all verification details accurately.
Junior Level Questions
Q: What's the difference between in-network and out-of-network PPO benefits?
Expected Answer: Should explain that in-network providers have agreed to specific rates with insurance companies, while out-of-network providers may charge more, resulting in higher patient costs.
Q: How do you submit a PPO claim?
Expected Answer: Should be able to describe basic claim submission process, including gathering necessary patient information, proper coding, and using electronic submission systems.
Experience Level Indicators
Junior (0-2 years)
- Basic insurance verification
- Simple claim submissions
- Patient communication
- Data entry and documentation
Mid (2-5 years)
- Insurance claim appeals
- Benefits explanation to patients
- Multiple PPO plan management
- Treatment plan cost estimates
Senior (5+ years)
- Contract negotiation with insurers
- Staff training and supervision
- Complex claim resolution
- Insurance revenue optimization
Red Flags to Watch For
- No experience with dental practice management software
- Poor understanding of insurance terminology
- Lack of attention to detail in documentation
- Weak communication skills with patients and insurance companies
