Dental Referral/Insurance Coordinator

Yakutat, Alaska, United States | Full-time

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POSITION TITLE: Dental Referral/Insurance Coordinator

POSITION LOCATION:  Yakutat Community Health Center (YCHC)

DEPARTMENT:  Community Health Services - Dental

POSITION UNDER THE SUPERVISION OF: Community Health Services Director

FUNDING SOURCE:  IHS

POSITION SUMMARY:

This position is responsible for coordinating specialty care referrals for patients that require specialty dental care not provided by the YCHC Dental Department, review with the patient the dental treatment plan and estimated insurance, IHS, Medicaid, Sliding Scale or Self-pay coverage.  This position will assist patients in understanding their insurance benefit and will work with insurance companies on the patient’s behalf to communicate insurance concerns, and manage any insurance disputes.

This position requires compliance with Health Center’s compliance standards, including its Standards of Conduct, Compliance Program, and policies and procedures. Such compliance will be an element considered as part of the position’s regular performance evaluation. 

DUTIES AND RESPONSIBILITIES:   

  1. Maintains the referral system used to assist patients in accessing services not provided by the YCHC Dental Department; sets up and maintains electronic and paper files for referral forms and assist with patient forms/letters of instruction regarding patient referrals and travel as needed.
  2. Verifies health insurance coverage and explains insurance benefits to patients.
  3. Schedules and coordinates appointments and transportation to appointments for patients needing outside specialty care; communicate with YCHC dental/medical providers and receiving providers, case managers, and patients to ensure patient appointments, travel arraignments, lodging, transportation and other logistics are completed as approved for medically necessary travel.
  4. Determines patient’s health care payment and eligibility; obtains pre-certifications/pre-authorizations for treatments required by insurers; works with Enrollment Specialist to assist patients with insurance coverage enrollment.
  5. Compiles and maintains a comprehensive file on all patients that require referring out to other specialties; sends all medical notes, demographics, and billing information to the outside provider; receives medical records from specialty care providers of visits that pertain to referrals obtained through the YCHC Dental Department.
  6. Tracks the patient’s appointments through completion and ensures the patient has proper follow-up until dental care is complete.
  7. Works directly with Indian Health Service (IHS) Purchased Referred Care (PRC) department in the coordination of services, and attends PRC meetings as scheduled for dental PRC patients.
  8. Enter data into the Electronic Health Record (EHR), and dental practice management software; generate reports for all activities.
  9. Post payments/deposits made by patients through front office payments; follow up on non-paid insurance claims; manage late payments and overdue accounts; and, monitor reports to confirm payment from clients and insurance companies.
  10. Cross train and assist the Dental Receptionist as needed.
  11. Maintains a procedure manual for position, updating as needed; and, maintains patient waiting areas.
  12. Coordinate and/or assist with special projects as assigned or requested. 
  13. Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
  14. Performs related duties.

KNOWLEDGE, SKILLS AND ABILITES:

  • Knowledge and experience in all facets of dental business office operations.
  • Knowledge of HIPAA.
  • Knowledge of patient registration principles.
  • Knowledge of regulations concerning patient's eligibility for services.
  • Knowledge of healthcare insurance systems including Medicare, Denali Kid Care, Private Insurance, and Fee-for-Service sufficient to appoint patients, inform patient of financial responsibility and explain provision and requirement to patient.
  • Knowledge of dental procedure terminology and insurance billing codes.
  • Knowledge and ability to communicate essential information to patients and families, such as in the scheduling of appointments and referrals.
  • Knowledge of modern office principles and practices.
  • Knowledge of computers and job-related software programs.
  • Knowledge of basic accounting principles, bookkeeping, budgeting, and financial reporting.
  • Knowledge of customer service principles.
  • Knowledge of the correct and effective use of English, including grammar, spelling, and punctuation.
  • Ability to communicate clearly and effectively, both orally and in writing, using tact and sensitivity.
  • Ability to prioritize and shift priorities to accommodate changing needs of the department.
  • Ability to organize the multiple demands of the job.
  • Ability to work well under pressure with minimal supervision.
  • Ability to work with personal computer and utilize a variety of software applications, including office software systems and EHR system.
  • Ability to work outside normal business hours and on weekends as needed.
  • Ability and willingness to travel.
  • Skill in time management, prioritizing and organizing work, and attention to detail.
  • Skill in interpersonal relations and customer service.
  • Skill in the maintenance of files and records.
  • Skill in the use of computers and job-related software programs.
  • Skill in the use of such office equipment as a computer, scanner, fax machine, and copier.
  • Skill in calculating financial fees and discounts.
  • Skill in oral and written communication.
  • Skill in problem-solving and conflict resolution.

QUALIFICATIONS:

  • High school diploma or equivalent.
  • Five (5) years of progressively responsible, related experience, sufficient to understand the major duties of the position, including two (2) years of office management experience.  Experience in a dental office environment, health care business office, medical insurance office, eligibility determination or other medical office related experience is preferred.
  • Current CPR certification or able to obtain CPR certification.
  • Must comply with YCHC immunization and Covid policy.
  • Must be dependable and punctual.
  • Possession of valid driver’s license issued by the State of Alaska with a clean driving record.
  • Must successfully pass a criminal and background check, and a pre-employment drug screen.