Prior Auth & Insurance Eligibility Specialist

Kintegra Health•Gastonia, NC

46m•Onsite

About The Position

The Prior Authorization & Insurance Eligibility Specialist is responsible for verifying insurance coverage and obtaining prior authorizations for dental procedures. This role plays a critical part in minimizing claim denials and helping patients understand their insurance benefits.

Requirements

High School Diploma Required
Must be able to sit, stand and walk for long periods of time.
Able to read and understand the English language.
Able to effectively maintain confidentiality of records and communicate with all levels of personnel.
Must have excellent verbal and written communication skills.
Requires effective customer relation skills, ability to organize and interpret data.
Requires good judgment, tact, diplomacy, and ability to problem solve.
Able to work effectively in a team environment.
Able to use a personal computer and related software.

Nice To Haves

Previous experience in a clinic setting preferred.

Responsibilities

Obtain prior authorizations for procedures based on the treatment.
Verify patient insurance eligibility and benefits before appointments and procedures
Communicate with insurance companies, dentists, and staff.
Document authorization details accurately in EDR.
Track authorization status and follow up as needed to ensure timely approvals.
Communicate authorization outcomes and cover details with providers, staff, and patients.
Stay up to date on insurance requirements, policies, and payer-specific guidelines.
Responsible for using online tools for benefits, reviewing dental criteria/policies and prior approval (PA) requirements, initiating and obtaining authorizations.
Responsible for identifying and correcting denials.
Handle all insurance inquiries daily.
Monitor and follow up on outstanding claims.
Perform other duties as required.