Dental Access Referral Coordinator

Dental Access Referral Coordinator

W2 Contract

Salary Range: $47,800 - $56,200 per year

Location: San Jose, CA - Remote Role

Job Summary:

This position is responsible for managing dental referrals, authorizations, provider network access, and provider relations. The role ensures members are matched with appropriate dental providers, supports dental network operations, and provides cross-functional assistance to 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 internal departments.
• Review referral submissions for completeness and ensure all required documentation is obtained.
• Facilitate referral requests and authorization determinations in accordance with established policies.
• Provide referral assistance and guidance to members.
• Monitor referral queue volumes daily and implement defined escalation processes as needed.
• Build and maintain strong relationships with network providers to support timely referrals and appointment scheduling.
• Serve as a subject matter expert on dental health benefits and provider network access.
• Collaborate with members, providers, and internal departments to improve referral workflows and member experience.
• Support provider recruitment, contracting, onboarding, and specialty provider engagement.
• Train and onboard the dental provider office staff on our policies and procedures.
• Maintain and update resources related to dental coding terminology, documented workflows, provider lists, and availability data.
• Track and report general and specialty provider access metrics.
• Identify, analyze, and escalate emerging access barriers and network trends to the Dental Benefits Manager. Bachelor's

Requirements and Qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, Social Sciences, or a related field required.
• One (1) to three (3) years of experience in a clinical or healthcare setting.
• Intermediate verbal and written communication skills.
• Intermediate proficiency with personal computers and Microsoft Office Suite applications (Outlook, Word, Excel, Teams, PowerPoint).
• Intermediate meeting management and facilitation skills.
• Basic knowledge of managed care principles and operations.
• Working knowledge of provider and network operations.
• Extensive knowledge of conflict resolution and process improvement principles.
• Extensive knowledge of healthcare billing practices, preferably related to dental services.
• Ability to work collaboratively and maintain cooperative working relationships.
• Ability to adapt to changing priorities and requirements.
• Ability to professionally represent the health plan in public and provider-facing settings.
• Demonstrated ability to interpret complex regulations, analyze issues, and implement sound recommendations.
• Ability to serve as a resource to others regarding 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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