Dental Claims Specialist

6 days ago


Roseville, United States Gainwell Technologies LLC Full time
About This Role

At Gainwell Technologies LLC, we're committed to harnessing the power of technology to improve the health and well-being of the communities we serve. As a Dental Claims Specialist, you'll play a vital role in helping our clients deliver better health and human services outcomes using innovative solutions.

This position offers a unique opportunity to contribute your skills and experience in a dynamic and growth-oriented environment. If you're passionate about healthcare and technology, we encourage you to explore this opportunity further.

Your Key Responsibilities
  • Review and approve treatment authorization request (TAR) claim lines that meet policy requirements.
  • Confirm TAR and/or claim documentation is complete and complies with policy.
  • Send resubmission turnaround documents (RTDs) to dental providers to correct mistakes or gather missing information from submitted TAR and claims.
  • Communicate and collaborate with dental consultants toward the goal of final adjudication.
  • Evaluate dental claims, adjustments, and prior authorization requests against Medi-Cal Dental criteria.
  • Generate requests to dental providers for missing claims information.
  • Confirm that claims documentation is complete, complies with policy, and refer documents to dental professionals when required.
Requirements
  • Graduate from an accredited dental assistant school, or two (2) years of prior experience working in a dental office as a paraprofessional (dental assistant, registered dental assistant, registered dental hygienist, etc.).
  • Ability to discern proper placement/orientation of dental radiographs.
  • Two (2) years prior experience in a dental billing and claims processing environment.
  • Good communication (oral and written) skills.
  • Expertise to support claim adjudication.
What We Offer
  • A hybrid work environment with 1-2 days a week in the office as needed for face-to-face and client meetings, with the remainder of time remote work.
  • The opportunity to work with a leading healthcare technology company.
  • A competitive compensation package.

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