Clinical Support Specialist, Dental (66795)

Department: Dental
Position: Clinical Support Specialist
Employee Category: Non-Exempt
Reporting Relationship: Dental Operations Manager

Character Qualities:

• Compassion—showing genuine care and concern for patients and their well-being.
• Reliability—consistently following through on commitments and maintaining dependable performance.
• Attention to Detail—carefully reviewing and processing information to ensure accuracy and quality.
• Adaptability—adjusting effectively to changing clinical protocols and patient needs.
• Teamwork—collaborating effectively with healthcare providers and support staff to achieve common goals.

Summary of Duties and Responsibilities:

Provides clinical support in key functions such as prior authorizations, equipment orders, and other duties that support key clinical workflows in the delivery of patient care. This role ensures that efficient processes are in place re: communication and authorizations are obtained to continue delivery of care.  

Primary Duties and Responsibilities:

1. Assists dental providers in obtaining approvals by payors in areas such as prior authorizations of procedures.
2. Verifying benefits and collecting deductible/co-insurance prior to procedures and pre-authorizations for patients that have private insurance.
3. Verifying proof of income for self-pay patients to determine payments for procedure(s) using sliding fee scaler prior to receiving procedure(s).
4. Understanding what to charge when a patient qualifies for the slide and has private insurance.
5. Manages the providers’ documents to ensure key actions are taken to obtain prior authorizations for dental procedures.
6. Reviews key documentation in patients dental record and MiPACS to obtain clinical information pertinent to obtain approval.
7. Proficient in EPIC charting, documentation, inbasket management, WQ management.
8. Contacts outside agencies and patients to ensure that approvals and denials are being obtained.
9. Contacts patients to schedule follow up appointments after approvals are obtained and communicates any payment responsibility on their behalf.  
10. Contacts patient to inform them about their denial and if any additional information needs to be sent out or if the patient will be responsible for entire/partial treatment.
11. Counsels patients as to estimate cost of procedure(s) and sets up payment plans.
12. Resubmits any denials and works with providers on documentation and codes for resubmittals.
13. Ability to explain treatment plan with patients.
14. Understanding of the CDT coding book and what codes are needed for pre-authorizations.
15. Keeps patients informed of progress or additional requests needed for approvals.
16. Communicates with providers and dental support team on progress or additional documentation required.
17. Meets productivity standards daily.
18. Supports quality improvement initiatives and participates in clinical audits as requested.
19. Keeps the providers informed of progress of prior authorizations and documentation required.
20. Participates in staff meetings and continuing education opportunities.
21. Maintains confidentiality of patient information in accordance with HIPAA regulations.
22. Supports clinic operations during provider absences or high-volume periods.
23. Establishes and maintains cooperative working relationships within the organization and community.
24. Supports Variety Care's accreditation as a Patient Centered Medical Home and our commitment to provide care to all Variety Care patients that is Safe, Effective, Patient Centered, Timely, Efficient and Equitable.
25. Provides leadership and works with all staff to achieve the goals of the "Triple Aim" of healthcare reform: improve the experien