Dental Services Authorization Specialist(Elk Ridge) - Flagstaff Fourth St - General Dentistry
About The Position
The Dental Services Authorization Specialist serves as a liaison among the Dental Business Office, in-house providers, external referral sources, health plans, and Elk Ridge Community Health patients and staff. The role supports patients by discussing coverage and treatment plans, preparing cost estimates, addressing claim denials, scheduling appointments, and providing providers with accurate approvals through the organization’s electronic authorization program. It also assists with staff training and workflow monitoring across sites to help meet departmental goals and provide excellent customer service. The position supports Elk Ridge Community Health’s mission to provide comprehensive, quality health care that is affordable and accessible. Responsibilities include working with commercial, Medicaid (AHCCCS), and Medicare plans; coordinating authorizations and utilization; reviewing and submitting claims; ensuring accurate ICD-10 and CDT coding; documenting authorization outcomes; and addressing patient concerns. The role also includes general accounting functions, data entry, educating staff about insurance and authorization changes, and maintaining a clean, safe, hygienic work environment in accordance with organizational policies and Joint Commission certification requirements. Employees are expected to represent Elk Ridge professionally, participate in community and health care activities, use organizational resources cost-effectively, accurately document work hours, and maintain proficiency with changing systems and software. Reliable transportation is required to meet possible operational reassignments during the workday. A valid driver’s license and compliance with Arizona vehicle insurance requirements are required when driving during work hours. Drug testing is required before employment, and additional testing may apply under the stated circumstances.
Requirements
- High school diploma or GED.
- Three years of experience in a health care setting involving authorizations, insurance coverage and benefits, claims, billing, and customer service.
- Three years of experience working with electronic health records (EHR).
- A current, valid Level I fingerprint clearance card in good standing, or application for one within seven working days after beginning employment.
- Reliable transportation that can accommodate operational reassignments during the workday.
- A valid driver’s license and compliance with Arizona vehicle insurance requirements when driving during work hours.
- Ability to maintain proficiency with organizational operating systems and software as requirements change.
- Employees must undergo drug testing before employment and may be subject to post-accident, reasonable suspicion, return-to-duty, and follow-up drug and alcohol testing.
Nice To Haves
- Bachelor’s degree in a health care-related field from an accredited college or university.
- Dental Assisting Program Certificate (DA III) and/or state certification.
- Certified Dental Billing Specialist (CDBS) certification.
- Certified Patient Account Technician (CPAT) certification.
- Bilingual English/Spanish ability, including speaking, reading, and writing in both languages.
Responsibilities
- Serve as a liaison between the Dental Business Office, in-house providers, external referral sources, health plans, patients, and staff.
- Meet with patients to discuss treatment plans, insurance coverage, and financial responsibilities, and prepare cost estimates.
- Schedule initial and follow-up appointments for complex treatment, including oral surgery and sedation cases.
- Perform authorization and utilization activities for dental insurance plans.
- Process authorization claim forms; review ICD-10 diagnostic and CDT procedural codes; and complete, submit, and reconcile authorization claims.
- Research, correct, and resubmit denials, and work to overturn claim denials.
- Ensure diagnostic and procedural coding is accurate, consistent, and standardized in dental treatment documentation.
- Coordinate procedure groupings and submission timeframes for treatment-plan authorization approvals, and determine the cost or utilization of grant funds for requests.
- Enter data into the electronic health record and specified reports in Excel or Elk Ridge Health systems.
- Document approvals, denials, and explanations in patient charts.
- Perform general accounting functions.
- Provide information and education in group settings about insurance and authorization changes or new coverage.
- Assist with staff training and monitor workflow at all sites.
- Maintain excellent customer service and address and resolve patient concerns.
- Maintain a clean, safe, and hygienic work environment and comply with applicable policies, procedures, and Joint Commission requirements.
- Represent Elk Ridge Community Health professionally and participate in community events and appropriate local, state, and national health care activities.
- Support cost-effective use of materials, supplies, equipment, and other organizational resources.
- Accurately document hours worked and ensure required approval is completed in a timely manner.
- Maintain proficiency with organizational operating systems and software and learn and demonstrate new skills as systems and programs change.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
