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Dental Referral & Authorization Specialist

Company: CareOregon
Location: Portland
Posted on: January 16, 2022

Job Description:

To protect the health and well-being of our members, employees and community, CareOregon requires all employees to be fully vaccinated against COVID-19 or have an approved medical or religious exception as a qualification of employment. Candidates who receive an offer of employment by CareOregon, must provide proof of COVID-19 vaccination or submit a medical or religious exception request, which will be evaluated in accordance with CareOregon's standard accommodation process. Position Title: Dental Referral and Authorization Specialist Department: Dental Title of Manager: Senior Manager, Dental Supervision: Non-supervisory position Exemption Status: Non-Exempt Work Hours: Monday - Friday, 8:00 AM to 5:00 PM Requisition ID: 18989 General Statement of Duties This position is responsible for coordinating dental referrals and pre-authorizations for PDP and specialty network affiliates. Core tasks include reviewing, processing, approving and matching members to the most appropriate specialty dental services in order to improve member access to specialty care and specialty provider network stability. This position also provides customer service and general support to the dental team as assigned. Essential Position Functions Process and Authorize Dental Referrals + Receives and processes referral and pre-authorization requests from PDP or specialty network affiliates based on department procedures; matches member with the most appropriate specialist. + Assures all clinical documentation has been received from the dental provider to assess, evaluate and complete referral and authorization request. + Approves referral and authorization requests per current policy and procedure and refers subset appropraitely for clinical review. + Assigns members to specific specialist based on member needs and provider availability and criteria. + When a denial is issued by a dental director, generates denial letter in accordance with State guidelines and CareOregon Dental policies and procedures. + Maintains rapport and relationships with the network to support workflows and timely submission and processing of referrals and authorizations. + Serves as a subject matter expert on dental benefits, coverage and dental provider access for CareOregon Dental. + Works with members, provider and customer service to remove barriers and resolve referral and authorization issues for members. Customer Service and Dental Team Support + Collaborates with members, customer service, provider relations, and claims to assist with referrals and other cross departmental issuess + Shares voice of customer feedback (member, provider, etc) with dental leadership in order to improve referral processes and quality. + Supports oral health promotion and escalation from across the organization. + Partners with the care coordinator on complex referrals or high-risk members. + Requests, organizes and prepares charts for quality and/or payment integrity chart reviews. + Performs other duties as assigned to support the work of the dental team. Essential Department and Organization Functions + Propose and implement process improvements. + Meet deadlines for completion of workload. + Maintain agreed upon work schedule. + Demonstrate cooperation and teamwork. + Provide cross-training on specific job responsibilities. + Meet identified business goals that contribute to departmental goals. + Perform other duties and projects as assigned. Knowledge, Skills and Abilities Required + Knowledge of or ability to quickly learn the following: + Oregon Health Plan and Medicaid Dental benefits + Covered/non-covered dental services and OARs + Dental terminology and dental coding + Dental clinic operations + Excellent customer service, written and verbal communication skills + Exceptional interpersonal and organizational skills that foster collaboration + Ability to effectively solve unique problems as they arise or identify when to escalate issues to appropriate department/supervisor + Demonstrated ability to develop and maintain excellent professional working relationships with PDPs and specialists + Ability to take accountability and initiative + Ability to support and comply with organizational policies, procedures and guidelines Physical Skills and Abilities Lifting/Carrying up to 10 Pounds Pushing/Pulling up to 0 Pounds Pinching/Retrieving Small Objects Crouching/Crawling Reaching Climbing Stairs Repetitive Finger/Wrist/Elbow/ Shoulder/Neck Movement 0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day Standing Walking Sitting Bending Seeing Reading Hearing Speaking Clearly 0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day More than 6 hours/day More than 6 hours/day More than 6 hours/day Cognitive and Other Skills and Abilities Required Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress. Education and/or Experience Minimum 2 years' experience in the healthcare industry required, with strong preference for experience with dental provider networks, dental coding, dental clinic operations, and scheduling. Bilingual/Spanish speaking skills preferred. Working Conditions + Environment: This position's primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis): ? Inside/office ? Clinics/health facilities ? Member homes ? Other: + Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee's personal vehicle, local transit, or other means of transportation may be used. + Equipment: General office equipment + Hazards: n/a Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment Veterans are strongly encouraged to apply. Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Keywords: CareOregon, Portland , Dental Referral & Authorization Specialist, Healthcare , Portland, Oregon

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