Summary:
Under the direction of the Dental Manager, the Dental Coordinator is responsible for coordinating all aspects of dental treatment plans, including incomplete plans, referrals, and prior authorizations. This role includes supporting all dental services, ensuring efficient communication, record-keeping, inventory control, and high-quality patient care. The Dental Coordinator will also assist in identifying issues with processes and help develop processes to ensure timely patient care and manage both internal and external referrals and prior authorizations.
ESSENTIAL DUTIES AND RESPONSIBILITIES:-
Communication: Conveys information accurately and efficiently. Written communication is direct, concise, and easy to understand. Ability to speak clearly and concisely.
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Decision-making: Gathers necessary information to make good and timely decisions. Uses sound judgment and instincts.
- Directing others/Delegation: Assesses other staff member abilities and provides coaching and recognition.
- Planning/Priority setting: Organizes tasks and objectives in order of importance, timing, and predicted results. Works within measurable goals and outcomes.
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Problem solving: Works systematically to solve problems. Develops reasonable and timely resolutions. Ability to make suggestions on workflow or systems.
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Initiative: Takes prompt action to accomplish objectives. Seeks to resolve problems without being asked.
KEY FUNCTIONS:
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Coordinate all aspects of incomplete treatment plans in a timely manner to ensure patients receive the care they need.
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Verify insurance coverage and obtain prior authorizations for services as required by individual insurance plans.
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Coordinate with the billing department and/or dental clinical staff as needed on prior authorizations, handle denied authorizations, and ensure proper management of claims.
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Ensure task box is managed efficiently, answering questions from support center staff regarding dental patients.
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Communicate information and updates to patients and providers.
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Document care coordination, telephone calls, and other relevant clinical information in EHR.
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Assemble paperwork and requested medical information and submit to specialty offices as needed for referrals or other patient coordination efforts.
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Ensure specialists accept the patient’s insurance plan.
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Establish and maintain professional relationships with all staff, providing excellent customer service.
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Inform leadership of concerns, backlogs, or insurance issues.
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Correspond with dental staff to ensure effective communication and scheduling.
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Plan and manage the infection control plan to meet OSHA, CDC, and ADA standards.
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Support and assist with special community outreach care programs.
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Prepare and mail follow-up correspondence to parents or patients.
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Call/correspond with parents to schedule students/patients with healthcare needs for office or telehealth visits.
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Assist providers in ensuring all patient records and documents are accurately completed and filed.
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Maintain patient confidentiality at all times.
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If credentials allow, provide clinical coverage as needed to fill temporary gaps in staffing.
REFERRAL MANAGEMENT:
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Document in the patient’s record the referral to specialty services, including the date of referral, name of the provider, and scheduled appointment date.
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Track dental specialty referrals using the Grace Health Referral Tracking process.
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Monitor the performance of specialty providers, ensuring quality care and removing any provider who does not meet standards.
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Establish formal or informal referral agreements with specialists.
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Manage referral agreements with specialists in more remote locations if local specialists are unavailable.
PRIOR AUTHORIZATION (PA):
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Monitor treatment plans for services that require prior authorization, and initiate PA process according to Standard Operating Procedure (SOP).
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Work PA by collaborating with dental clinical and billing staff to (re)submit the required information.
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Communicate with patients and staff as necessary to move through the PA process and ensure the patient receives the treatment they need.
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Monitor in-progress PA requests to ensure timely documentation and follow up.
OTHER SERVICE LINES:
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Assist with coordination with schools to schedule patients, check eligibility and benefits, enter demographics, scan documents, or abstract data as needed.
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Work with other entities to coordinate care with our clinic sites, such as scheduling appointments, coordinating paperwork, and communication with the entity for coordination of care, billing, and other needs.
OTHER ESSENTIAL DUTIES and RESPONSIBILITIES:
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Grace Health recognizes that managing patient care is a team effort that involves clinical and non-clinical staff. All employees must embrace a team-based approach to patient care and understand that each role is important to our success.
- Team members must demonstrate excellent team communication and coordination to provide quality patient care.
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Care coordination includes communicating with community organizations, health plans, facilities, and specialists.
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Care team members understand and embrace the concept of population management and proactively address the needs of patients and families served by this practice.
- Team members must demonstrate skill and knowledge related to effective communication with vulnerable patient populations.
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Team members must participate in Continuous Quality Improvement activities within the organization to ensure patients receive high quality care.
- All team members will be involved in the process of improving quality outcomes.
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Team members will participate in the review and evaluation processes of practice performance and help to identify opportunities for improvement.
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Team members will participate in Grace Health's advocacy program.
GENERAL DUTIES:-
Follows policies and procedures of the clinic and evidence-based guidelines for patient care.
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Maintains good attendance and adheres to staff requirements outlined in the Employee Handbook.
- Maintains professional appearance.
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Maintains timely documentation of all work assignments.
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Maintains patient confidentiality at all times.
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Routinely keeps supervisor informed.
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Flexible in being able to multi-task.
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Work effectively and at an efficient pace.
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Work cooperatively with providers, leadership, and peers.
QUALIFICATION REQUIREMENTS:
To perform this job successfully, an individual must be able to assist in advancing Grace Health’s mission and to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
SKILLS:-
Pleasant personality and professional demeanor.
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Cooperative attitude and flexibility.
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Detail-oriented with the ability to work with minimal supervision.
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Highly organized with the ability to prioritize tasks.
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Intermediate computer skills with Microsoft Word and Excel.
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Familiarity with Electronic Medical Records.
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Strong communication, decision-making, and problem-solving skills.
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Ability to manage multiple tasks and maintain professional relationships
EDUCATION and/or EXPERIENCE:
- High school diploma or equivalent required.
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Experience with dental services, referrals and authorizations preferred.
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At least 1 year of dental office experience preferred.
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Basic Life Support (BLS) certification required.
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Participation in continued education.
Grace Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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