Market Range: 06
Hiring Salary: $19.67/Hourly
JOB SUMMARY/ESSENTIAL JOB FUNCTIONS:
The Dental Claims Coordinator for the Special Needs Clinic oversees all dental insurance billing, claims processing, and provider credentialing for AEGD, UDP, and Special Needs Clinic. This position ensures accurate, timely claims and pre-authorizations, with a strong focus on services commonly required by patients with special health care needs such as hospital-based dentistry, sedation, and multidisciplinary treatment. This position serves as the clinic's subject matter expert on CDT coding, payer requirements, and documentation standards for insurance.
EDUCATION:
High School Diploma or GED. (TRANSCRIPT REQUIRED)
EXPERIENCE:
Four (4) years of public and private dental claims processing; OR Associate's Degree and two (2) years of public and private dental claims processing.
KNOWLEDGE, SKILLS, AND ABILITIES:
- Ability to organize and prioritize work to meet competing deadlines.
- Knowledge of special needs patient population guidelines, regulations, policy, and procedures
- Knowledge of public and private dental insurance billing policies.
- Ability to manage multiple job priorities and tasks efficiently, effectively, and accurately while demonstrating close attention to detail.
- Expert knowledge of dental terminology, treatment planning, CDT coding, accounts receivable and collections processes.
- Ability to communicate professionally and courteously with faculty, residents, students, patients and staff.
- Ability to identify, research and/or resolve financial conflicts with insurance companies and patient accounts.
- Prepares and submits insurance claims and pre-authorizations (electronic and paper); monitors all unsubmitted or denied claims.
- Identifies and resolves payment issues proactively, coordinating with payers to obtain claim approvals.
- Audits patient records for accurate financial and CDT coding documentation; initiates corrections and communicates with providers to ensure compliant submissions.
- Collaborates with the hospital to create a streamlined process (create and monitor PAs, insurance coordination, and hospital coordination).
- Assists students, residents, and staff in understanding insurance protocols.
- Maintain up-to-date knowledge of CDT coding, Medicaid/Medicare rules, and payer regulations for dentistry.
- Explains treatment costs and insurance coverage.
- Performs other duties as assigned.
- Prepares and submits insurance claims and pre-authorizations (electronic and paper); monitors all unsubmitted or denied claims.
- Identifies and resolves payment issues proactively, coordinating with payers to obtain claim approvals.
- Audits patient records for accurate financial and CDT coding documentation; initiates corrections and communicates with providers to ensure compliant submissions.
- Collaborates with the hospital to create a streamlined process (create and monitor PAs, insurance coordination, and hospital coordination).
- Assists students, residents, and staff in understanding insurance protocols.
- Maintain up-to-date knowledge of CDT coding, Medicaid/Medicare rules, and payer regulations for dentistry.
- Explains treatment costs and insurance coverage.
- Performs other duties as assigned.