Job Information

Title: Prior Authorization & Insurance Eligibility Specialist

Department: Dental

Status: Hourly

Location: Assigned Location

Reports To: Dental Area Manager

Direct Reports: None

Summary of Position:

The Prior Authorization & Insurance Eligibility Specialist is responsible for verifying insurance coverage and obtaining prior authorizations for dental procedures. This role plays a critical part in minimizing claim denials and helping patients understand their insurance benefits.

Position Requirements:

Licensure/Certification: None
Education: High School Diploma Required
Experience: Previous experience in a clinic setting preferred.
Knowledge/Skills: Must have excellent verbal and written communication skills. Requires effective customer relation skills, ability to organize and interpret data. Requires good judgment, tact, diplomacy, and ability to problem solve. Able to work effectively in a team environment. Able to use a personal computer and related software.
Minimum Qualifications: Must be able to sit, stand and walk for long periods of time. Able to read and understand the English language. Able to effectively maintain confidentiality of records and communicate with all levels of personnel.

Job Responsibilities:

Obtain prior authorizations for procedures based on the treatment.
Verify patient insurance eligibility and benefits before appointments and procedures
Communicate with insurance companies, dentists, and staff.
Document authorization details accurately in EDR.
Track authorization status and follow up as needed to ensure timely approvals.
Communicate authorization outcomes and cover details with providers, staff, and patients.
Stay up to date on insurance requirements, policies, and payer-specific guidelines.
Responsible for using online tools for benefits, reviewing dental criteria/policies and prior approval (PA) requirements, initiating and obtaining authorizations.
Responsible for identifying and correcting denials.
Handle all insurance inquiries daily.
Monitor and follow up on outstanding claims.
Perform other duties as required.

Kintegra Health Core Requirements

Patient First – An approach to care that holds primary, the well-being and desires of the patient
Build not Blame – Focusing first on finding fault with the process rather than the person
Integrity and Honesty – Fostering an acceptance of openness, honesty, and fairness in words, deeds and the use of organizational resources judiciously for both internal and external customers
Cooperation and Flexibility – Related to an internal believe that we function as part of an interdependent team with only shared gains or losses thereby committed to assisting whenever possible beyond the prerequisite job description
Culturally Sensitive – Always working toward increasing one’s ability to understand, communicate with, effectively interact and care for people across cultures, while having an acute awareness of one’s own culture.

Kintegra Health is a is a community sponsored, family-centered provider of health care, health education and preventive care services without regard to the ability to pay. We screen potential employees to first ensure alignment with our core requirements followed by the requisite position skills set. In doing so we need staff committed to this mission who do their best to live and work the characteristics of our core values as we strive to care for ever increasing members of the communities we serve.

Our goals are:

To provide continuing comprehensive and accessible primary care services to individuals and families of all economic levels within the counties we service.
To provide primary care services to meet the physical as well as social health needs of individuals and families, promoting health maintenance, providing timely diagnostics, treatment and referral services.
To emphasize preventive care through patient and community education to help individuals become aware and responsible for their own health behaviors.

To employ an interdisciplinary team approach in collaboration with other community providers to provide a continuum of appropriate patient/family-oriented care in a cost-effective manner.

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Prior Auth & Insurance Eligibility Specialist