Performs a variety of specialized tasks involved in verifying insurance eligibility and benefits, obtaining pre-certification and authorizations for healthcare, Oral Surgery and dental services and procedures as well as Dental Surgeries. Provides comprehensive financial counseling to patients regarding their Dental and Healthcare services.  Collects co-payments, deductibles, prepayments and payments on outstanding balances. Schedules appointments for all Oral surgery and Dental appointments. Post Dental payments into the Kodak system.

Work Performed

Scheduling:

·         Register new patients at the time of their a ppointment request for all Dental and Oral Surgery referral, etc.

·         Determine most appropriate provider, service, and location for appointment based on scheduling guidelines, provider preferences, and patient/referring provider for all Dental /Oral Surgery request.

·         Serves as a resource and expert on division-specific scheduling guidelines including recommendations regarding access for Dental and Oral Surgery services.

·         Request outside records, Dental X-Ray ensure receipt of records prior to scheduling any Dental services.

·         Determine if scheduling Dental or Medical (TMJ)

·         Verify insurance eligibility and benefits for reimbursement for any and all Dental Services.

·         Responsible for scheduling all Oral Surgery/Dental appointments, received via telephone, email, internet, electronic medical record and fax.

·         Call patient and educate them about Dental appointments and financial responsibilities.

·         Create a referral for all Dental/Oral Surgery request into the system and attach to the referral to the Dental appointment.

Provide financial counseling to reach account resolution

·         Provide financial counseling to patients regarding outstanding patient liability- co pays, coinsurance and (self-pay) balances for healthcare and Dental services.

·         Estimate/determine fees for Dental services as well as medical and assist patients with expected payment they may be responsible for.

·         Implement appropriate collection actions and assist financially responsible persons in arranging payments at the time of service.

·         Inform provider of patient financial hardship such as no Dental insurance, charity care,  etc.

·         Request interpreter services when appropriate and notify provider/staff

·         Counsel patients and completethe managed care waiver form forpatients considered out of network andreceiving Dental services.

Pre-authorizations/Authorizations/Referrals

·        Obtain authorizations based on insurance plan contracts/guidelines, for Dental plans as well as medical plans and document in Maestro Care system per policy and procedure.

·         Obtain authorization for all Dental procedures and Surgeries

·         Update referrals as required in order to place the authorization for Dental services, etc within the referral.

·         Communicate with physicians and medical staff to obtain clinical information required for the authorization process as needed.

·         Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment for specific patients and Dental services.

·         Communicate with all Dental patients regarding their benefits resulting in approval or denials in a timely manner.

Payment Posting

·         Enter all prepayment amounts into the maestro system to ensure payment is made prior to all Dental procedures/surgeries

·         Maintain spread sheet of all payments/as well as maintain receipts

Attend meetings andtraining sessions:

·         Attend staff meetings and other clinic meetings as requested

·          Participate in all system regulatory and policy training

·         Attend FCC education sessions.