Job Description
Note: The job is a remote job and is open to candidates in USA. Bayside Solutions is seeking a Dental Access Referral Coordinator to manage dental referrals and provider relations. The role involves ensuring members are matched with suitable dental providers and providing support across various internal teams.
- Responsibilities
- Receive and process referral requests and authorizations from members, primary care dentists, medical providers, and internal departments
- Review referral submissions for completeness and ensure all required documentation is obtained
- Facilitate referral requests and authorization determinations in accordance with established policies
- Provide referral assistance and guidance to members
- Monitor referral queue volumes daily and implement defined escalation processes as needed
- Build and maintain strong relationships with network providers to support timely referrals and appointment scheduling
- Serve as a subject matter expert on dental health benefits and provider network access
- Collaborate with members, providers, and internal departments to improve referral workflows and member experience
- Support provider recruitment, contracting, onboarding, and specialty provider engagement
- Train and onboard the dental provider office staff on our policies and procedures
- Maintain and update resources related to dental coding terminology, documented workflows, provider lists, and availability data
- Track and report general and specialty provider access metrics
- Identify, analyze, and escalate emerging access barriers and network trends to the Dental Benefits Manager
- Skills
- Bachelor's degree in Business Administration, Health Care Administration, Social Sciences, or a related field required
- One (1) to three (3) years of experience in a clinical or healthcare setting
- Intermediate verbal and written communication skills
- Intermediate proficiency with personal computers and Microsoft Office Suite applications (Outlook, Word, Excel, Teams, PowerPoint)
- Intermediate meeting management and facilitation skills
- Basic knowledge of managed care principles and operations
- Working knowledge of provider and network operations
- Extensive knowledge of conflict resolution and process improvement principles
- Extensive knowledge of healthcare billing practices, preferably related to dental services
- Ability to work collaboratively and maintain cooperative working relationships
- Ability to adapt to changing priorities and requirements
- Ability to professionally represent the health plan in public and provider-facing settings
- Demonstrated ability to interpret complex regulations, analyze issues, and implement sound recommendations
- Ability to serve as a resource to others regarding relevant laws and regulations
- Dental referral management
- Referral processing and authorization
- Dental provider network access
- Provider relations management
- Care coordination support
- Customer support collaboration
- Claims and provider services coordination
- Healthcare workflow management
- Member assistance and guidance
- Referral queue monitoring and escalation
- Appointment scheduling coordination
- Dental benefits expertise
- Managed care principles
- Provider network operations
- Provider recruitment and onboarding
- Provider contracting support
- Specialty provider engagement
- Provider training and education
- Dental coding terminology
- Healthcare billing practices (dental)
- Documentation review and compliance
- Resource and workflow documentation
- Provider data and availability management
- Access metrics tracking and reporting
- Network access analysis
- Access barrier identification and escalation
- Process improvement
- Conflict resolution
- Cross-functional collaboration
- Regulatory interpretation and compliance
- Healthcare policy application
- Microsoft Office (Outlook, Word, Excel, Teams, PowerPoint)
- Meeting facilitation
- Verbal and written communication
- Data analysis
- Relationship building
- Adaptability to changing priorities
- Professional representation of health plans
- Company Overview
- Bayside Solutions is a staffing and recruiting company offering IT, telecom, and scientific staffing services. It was founded in 2001, and is headquartered in San Ramon, California, USA, with a workforce of 51-200 employees. Its website is https://baysidesolutions.com/.
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