Dental Referral and Authorization Specialist

CareOregon • Washington, DC

1d • $26 - $32 • Remote

About The Position

This position is responsible for coordinating dental referrals and pre-authorizations for PDP and specialty network affiliates. Core tasks include reviewing, processing, approving and matching members to the most appropriate specialty dental services in order to improve member access to specialty care and provider network support. This position also provides customer service and general support to the dental team as assigned.

Requirements

• Minimum 3 years’ experience in the dental industry.
• Experience with dental provider networks, dental coding, dental clinic operations, and/or scheduling
• Knowledge of or ability to quickly learn the following: Oregon Health Plan and Medicaid Dental benefits, Covered/non-covered dental services and OARs, Dental terminology, dental charting, and dental coding, Dental clinic operations
• Excellent customer service, written and verbal communication skills
• Excellent critical thinking skills
• Exceptional interpersonal and organizational skills that foster collaboration
• Ability to effectively solve unique problems as they arise or identify when to escalate issues to appropriate department/supervisor
• Ability to develop and maintain excellent professional working relationships with PDPs and specialists
• Ability to take accountability and initiative
• Ability to support and comply with organizational policies, procedures and guidelines
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day

Nice To Haves

• Candidates must be located in the Portland, Oregon and/or Vancouver, Washington area.

Responsibilities

• Process and Authorize Dental Referrals: Receive and process referral and pre-authorization requests from PDP or specialty network affiliates based on department procedures; match member with the most appropriate specialist.
• Assure all clinical documentation has been received from the dental provider to assess, evaluate and complete referral and authorization request.
• Approve referral and authorization requests per current policy and procedure and refers subset appropriately for clinical review.
• Assign members to specific specialists based on member needs and provider availability and criteria.
• When a denial is issued by a dental director, generates denial letter in accordance with State guidelines and CareOregon Dental policies and procedures.
• Maintain rapport and relationships with the network to support workflows and timely submission and processing of referrals and authorizations.
• Serve as a subject matter expert on dental benefits, coverage and dental provider access for CareOregon Dental.
• Work with members, providers and customer service to remove barriers and resolve referral and authorization issues for members.
• Customer Service and Dental Team Support: Collaborate with members, customer service, provider relations, and claims to assist with referrals and other cross-departmental issues.
• Share voice of customer feedback (member, provider, etc.) with dental leadership in order to improve referral processes and quality.
• Support oral health promotion and escalation from across the organization.
• Partner with the care coordinator on complex referrals or high-risk members.
• Identify tooth numbers when reviewing them in radiographs and in dental charting.
• Understand dental chart components: CDT codes related to referral, teeth in referral properly planned for restoration or removal, periodontal charting numbers.
• Use critical thinking with specific guidelines and dental knowledge before sending a referral to Dental Director for review.
• Request, organize and prepare charts for quality and/or payment integrity chart reviews.
• Perform other duties as assigned to support the work of the dental team.
• Network Adequacy and Access to Dental Services: Track and report general and specialty provider access; identify, analyze and escalate emerging barriers and trends to dental leadership.
• Assist providers via Dental Access Team phone line to answer questions or gather information.
• Assess limitations in capacity, utilization and access to oral health providers; offer solutions to program leadership and team members to improve utilization and access in underserved areas.
• Remove barriers for members and providers through improvements in the referral process.

Benefits

• competitive pay
• bonus opportunity
• medical, dental, vision, life, AD&D, and disability insurance
• health savings account
• flexible spending account(s)
• lifestyle spending account
• employee assistance program
• wellness program
• discounts
• multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
• strong retirement plan with employer contributions
• PTO and Paid State Sick Time
• paid holidays
• volunteer time
• jury duty
• bereavement leave

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed