Title : Dental Assistant / Hygienist - Remote
Shift : 8am-5pm, Monday-Friday
Description :
- Evaluate dental claims, adjustments, and prior authorization requests against Medi-Cal Dental criteria.
- Generate requests to dental providers for missing claims information.
- Confirm that claims documentation is complete, and complies with policy, and refer documents to dental professionals when required.
- Monitor members actively receiving appropriate care / scheduled care and ensure they complete their goals.
- Maintain and record decisions, actions, and outcomes for members receiving care coordination.
- Set up tasks, reminders, and follow-ups on missed appointments
What we're looking for :
- Graduate from an accredited dental assistant school or two (2) years of prior experience working in a dental office (dental assistant, registered dental assistant, registered dental hygienist, etc).
- Two (2) years prior experience in a dental billing and claims processing environment.
- Expertise to support treatment authorization requests (TAR) and claims adjudication, including familiarity with principles of dental radiography, such as orientation and tooth / structure identification.
Your role in our mission :
- Evaluate dental claims, adjustments, and prior authorization requests against Medi-Cal Dental criteria.
- Generate requests to dental providers for missing claims information.
- Confirm that claims documentation is complete, and complies with policy, and refer documents to dental professionals when required.
- Monitor members actively receiving appropriate care / scheduled care and ensure they complete their goals.
- Maintain and record decisions, actions, and outcomes for members receiving care coordination.
- Set up tasks, reminders, and follow-ups on missed appointments
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