Dental Claims Coordinator- Special Needs

Market Range: 06

Hiring Salary: $19.67/Hourly

JOB SUMMARY/ESSENTIAL JOB FUNCTIONS: The Dental Claims Coordinator for the Special Needs Clinic oversees all dental insurance billing claims processing and provider credentialing for a clinic dedicated to patients with intellectual developmental or complex medical conditions. This position ensures accurate timely claims and pre-authorizations with a strong focus on services commonly required by patients with special health care needs such as hospital-based dentistry sedation and multidisciplinary treatment. This position serves as the clinics subject matter expert on CDT coding payer requirements and documentation standards to secure coverage for specialized care.

DUTIES AND RESPONSIBILITIES:

1. Performs daily verification of patient insurance eligibility focusing on coverage for special-needs-specific services such as anesthesia behavioral support or hospital procedures.
2. Audits patient records for accurate financial and CDT coding documentation; initiates corrections and communicates with providers to ensure compliant submissions.
3. Prepares and submits insurance claims and pre-authorizations (electronic and paper) and monitors all unsubmitted or denied claims.
4. Identifies and resolves payment issues proactively coordinating with families caregivers and payers to expedite approvals for medically necessary services.
5. Guides patients caregivers and social service advocates through the insurance and reimbursement process for complex treatment plans.
6. Processes patient reimbursement requests ensuring compliance with documentation and coding requirements.
7. Supports scheduling and billing processes for lengthy or hospital-based appointments unique to special-needs dentistry.
8. Completes and maintains provider credentialing with commercial and government payers.
9. Performs other duties as assigned.

MINIMUM REQUIREMENTS:

EDUCATION:High School Diploma or GED.(TRANSCRIPT REQUIRED)

EXPERIENCE: Four (4) years of public and private dental claims processing; OR Associates Degree and two (2) years of public and private dental claims processing.

KNOWLEDGE SKILLS AND ABILITIES:

• Ability to organize and prioritize work to meet competing deadlines.

• Knowledge of special needs patient population guidelines regulations policy and procedures

• Knowledge of public and private dental insurance billing policies.

• Ability to manage multiple job priorities and tasks efficiently effectively and accurately while demonstrating close attention to detail.

• Expert knowledge of dental terminology treatment planning CDT coding accounts receivable and collections processes.

• Ability to communicate professionally and courteously with faculty residents students patients and staff.

• Ability to identify research and/or resolve financial conflicts with insurance companies and patient accounts.