Dental Services Authorization Specialist - Grant - Adult Dental

Schedule: Monday - Friday 8:00am to 5:00pm

Salary: $16.50 - $22.10 depending on qualifications

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:

• Associate's 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 medical and dental procedural descriptions.
• Bilingual (English/Spanish) with the ability to speak, read and write in both languages

El Rio Health is a diverse and inclusive organization. We are invested in helping you and your family Create Tomorrow.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

El Rio Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age 40 and over, disability, genetic information, military status, ancestry, marital status, familial status, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

El Rio Health requires all employees (except those 100% working remotely) to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. If the prospective employee does not possess this prior to hire, fingerprint application must be completed within 7 days post hire.

All employees are strongly recommended to obtain COVID 19 and maintain vaccination status (i.e. as recommended by CDC and/or other public health agencies) to include an Influenza vaccination. Personnel who decline to receive COVID 19 and/or flu vaccination per most recent CDC recommendations will be recommended to wear a facemask while in an El Rio Health facility, including both clinical and non-clinical areas from November 1 to April 30 (subject to change depending on viral activity). Subject to exemptions and accommodations when required by law.

All employees are required to undergo drug testing prior to employment and, will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.

El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards. El Rio Health is an equal opportunity employer.