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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.