JOB PURPOSE: The Dental Services Authorization Specialist(Elk Ridge) serves as a liaison between the Dental Business Office, in-house providers, external referral sources and health plans while providing service excellent to Elk Ridge Community Health patients and staff. The Dental Services Authorization Specialist(Elk Ridge) 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 Elk Ridge 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 Elk Ridge team members.
The primary goal of the Elk Ridge Community Health Dental Services Authorization Specialist(Elk Ridge) is to support Elk Ridge’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.
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 Elk Ridge 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, addresses and resolves patient concerns.
Joint Commission Responsibilities:
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.
Other Duties and Responsibilities:
In support of the Mission and Vision of Elk Ridge Community Health, will at all times represent themselves as a professional role model of Elk Ridge Community Health serving as a positive informational source for members of the community.
Supports Elk Ridge Community Health by participating in community events which promote good health, and which contribute to a broader awareness and understanding of Elk Ridge Community Health and the many services provided to the community.
Participates in all appropriate health care activities related to Elk Ridge Community Health on a local, state, and national level to maintain and enhance Elk Ridge’s image with health agencies, professional associations, and the general public.
Ensures and supports the cost-effective use of materials, supplies, and equipment by limiting waste of all…