Care Coordination Representative

Western Dental Orange , CA 92856

Posted 2 months ago

Processing of Medicaid/Medical treatment referrals and authorizations. Responsible for monitoring backlog of NEA and TAR at office level, processing pending items and tracing of open referrals/treatment authorizations.

  • Run weekly reports for pending referrals, referrals and/pre-authorizations

  • Submit referrals/ pre-authorizations requests

  • Process attachments through NEA

  • Keep daily log of referrals/ pre-authorizations submission

  • Request any additional attachments that are needed from the dental office in order to submit referrals/ pre-authorizations request

  • Research and follow-up on referrals/ pre-authorizations and reprocess as needed

  • Coordinate approved referrals to contracted specialty providers

  • Contact dental carriers as needed for follow

  • Verify eligibility as needed

  • Stay up to date with payer reimbursement changes

  • Case Management

  • Management of charge backs

  • Communication with offices and teams (written and verbal)

  • Act as Subject Matter Expert for Medicaid/Medical treatment referrals

  • Ability to travel to locations as needed

Requirements

  • Dental experience preferred

  • Knowledge Managed Care, Denti-Cal and Medicaid, preferred

  • Ability to multitask

  • Good customer service and communication skills

  • Easily adapts to change

  • Other duties as assigned by direct supervisor

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Care Coordination Representative

Western Dental