Dental Access Referral Coordinator

Dental Access Referral Coordinator

W2 Contract

Salary Range: $47,800 - $53,600 per year

Location: South San Francisco, CA - Remote Role

Job Summary:

This role handles dental referrals, authorizations, network access, and provider relations. Key duties include matching members to suitable dental providers, managing dental network activities, and offering support to the Care Coordination, Customer Support, Claims, and Provider Services teams.

Duties and Responsibilities:

• Receive and process referral requests and authorizations from members, primary care dentists, medical providers, and other departments.
• Review referral information and ensure that all necessary information is provided.
• Facilitate referral requests and authorizations.
• Provide member referrals.
• Monitor the referral queue volume daily and implement the defined escalation process as needed.
• Maintain rapport and relationships with the network to support workflows, timely referrals, and appointment scheduling.
• Serve as a subject matter expert on dental health benefits and dental provider network access.
• Collaborate with members, providers, and other departments to improve the referral process.
• Support and facilitate provider recruitment, contracting, and onboarding; assists in the recruitment of specialty providers.
• Onboard dental provider staff to our policies and procedures.
• Maintain and update resources in dental coding terminology, documented workflows, and provider lists and availability.
• Track and report general and specialty provider access; identify, analyze, and escalate emerging barriers and trends to the Dental Benefits Manager.

Requirements and Qualifications:

• Bachelor's degree in business administration, health care administration, social sciences, or related field.
• One (1) to three (3) years' experience in a clinical or health care setting.
• Intermediate verbal and written communication skills.
• Intermediate proficiency in personal computers and in Microsoft Office Suite applications, including Outlook, Word, Excel, Teams, and PowerPoint.
• Intermediate meeting management and facilitation skills.
• Basic knowledge of principles and operations of managed care.
• Working knowledge of provider and network operations.
• Extensive knowledge of billing practices in health care, preferably related to dental services.
• Ability to work cooperatively with others.
• Ability to adapt to changes in requirements/priorities for daily and specialized tasks.
• Ability to professionally represent the plan in a variety of public settings.
• Demonstrated ability to understand, analyze, and make sound recommendations and implementations based on complex regulations.
• Demonstrated ability to serve as a resource to others on relevant laws and regulations.

Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate.

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