Dental Claims & Prior Authorizations Specialist

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Job Type

Full-time

Description

POSITION SUMMARY

The Dental Claims Specialist & Prior Authorization Coordinator assesses insurance claims for patient visits to a dental office. These claims could include any procedure performed by a dentist on a patient's teeth, which might cover everything from essential cleanings to surgical procedures. The Dental Claims Specialist & Prior Authorization Coordinator ensures each claim is complete and the treatment received meets all the criteria for coverage as laid out by the insurance company. The position will need an understanding of the terminology that a dentist would use and the criteria that insurance companies use to assess claims, and will act as the point of contact providing dental management assistance between providers and insurance companies. This position will work directly with insurance companies to submit required dental procedure prior authorization to ensure procedure coverage and timely payment

REPORTING RELATIONSHIPS

This position reports to the Director of Dental Operations.

ESSENTIAL JOB DUTIES AND FUNCTIONS

While living and demonstrating our Core Values, the Dental Claims & Prior Authorizations Specialist will:

• Adjudicate dental claims based on prescribed guidelines for the purpose of processing claims according to policy and contract requirements. Including online/electronic claims, requesting necessary information, completing claim adjustment requests and referencing benefit policies.
• Monitor claim turnaround time reports and daily checks for claim accuracy
• Request any needed information to constituents in order to effectively and efficiently resolve outstanding claims issues.
• Review chart documentation to ensure patient dental policy guidelines, prioritize authorization requests accordingly to urgency
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payor dental policy guidelines, confirm accuracy of dental procedure codes, contact patients to discuss authorization status.

Requirements

REQUIRED QUALIFICATIONS

• Meet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education EOS People Analyzer Tool
• Buy in and experience working in the EOS model (strongly preferred)
• Mission-oriented; represents the enterprise in a professional manner while demonstrating organizational pride
• High school diploma or equivalent
• 3-5 years of dental claims processing and prior authorization experience
• Experience with Dexis and Dentrix dental billing software
• Able to multi-task without losing quality work
• Knowledge of dental terminology and radiographs