Dental Services Authorization Specialist - Southwest - Adult Dental

Schedule: Monday - Friday, 8am - 5pm
Salary: $16.50 - $22.10


JOB PURPOSE: The Dental Services Authorization Specialist serves as a liaison between the Dental Business Office, in-house providers, external referral sources and health plans while providing service excellent to El Rio Health patients and staff. The Dental Services Authorization is responsible to meet with patients regarding their coverage, prepare cost estimates through the treatment plan, work claim denials, schedule appointments, and supply providers with accurate approvals through the El Rio Health electronic authorization program. Assists with training staff, and monitoring of workflow at all sites to ensure the department meets the assigned goals and consistently provides world class customer service to patients, providers and all El Rio Health team members.
The primary goal of the El Rio Health Dental Services Authorization Specialist is to support El Rio’s Mission of providing comprehensive, quality health care that is affordable and accessible to all who may have healthcare needs, by successfully performing the primary essential functions.
Essential Job Functions:
• Demonstrates knowledge of Commercial, Medicaid (AHCCCS) and Medicare insurance plans.
• Schedules initial and follow-up appointments, for the most complex treatment such as oral surgery, and sedation cases.
• Performs Authorization and utilization of dental insurance plans.
• Processes authorization claim forms, reviews ICD-10 diagnostic and CDT procedural codes, and overturning denials.
• Utilizes billing and coding knowledge and skills to ensure ICD-10 diagnostic coding and CDT procedural codes are consistent and accurate and standardized in documenting dental treatment.
• Completes, submits, and reconciles authorization claim forms.
• Enters Data entry into electronic health record and/or specified reports in Excel or El Rio Health systems.
• Research, corrections and re-submission of denials.
• Correlates procedure groupings and timeframes for submitting all or part of the treatment plan for authorization approvals. Determining cost or utilization of grant funds when submitting authorization requests.
• General accounting functions.
• Meets with patients to discuss treatment plans, insurance coverages and financial responsibilities.
• Knowledge and experience submitting authorization requests in-house and/or to outside vendor.
• Documentation of approvals, denials, and explanations in the patient’s chart.
• Informs and educates updates regarding insurance and authorization changes or new coverages in a group setting.
• Maintains an exceptional level of customer service, address and resolve patient concerns
• Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position
• Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.
Minimum Education and Experience:
• Associates Degree in Healthcare Administration or a related field from an accredited college or university.
• Three (3) years’ experience working in a healthcare setting with authorizations, insurance coverage and benefits, claims, billing, and customer service.
• Three (3) years’ experience working with Electronic Health Records (EHR.)

If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.

Required Licenses, Certifications, and Registrations:
• Current certification in Basic Life Support (BLS) for health care providers.
• Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.
• Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.

Preferred Education, Experience, Skills, Abilities:
• Bachelor’s Degree in a health care related field from an accredited college or university.
• Dental Assisting Program Certificate (DA III) and/or state certified.
• Strong customer service experience and a demonstrated ability to perform in a professional manner with internal and external customers.
• Certified Dental Billing Specialist (CDBS)
• Certified Patient Account Technician, (CPAT)
• Ability to interpret