Summary
At Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve -
a community's most vulnerable. Gainwell empowers you to help clients deliver better health and human services outcomes using innovative technology and solutions, enabling you to design your career for
growth, new possibilities, and refinement of your valuable skills. Here are the details on this position.
Your role in our mission
* 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.
What we're looking for
* 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.
* 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.).
* Two (2) years prior experience in a dental billing and claims processing environment.
* Good communication (oral and written) skills.
* Expertise to support treatment authorization request (TAR) and claim adjudication, including familiarity with principles of dental radiography, such as orientation and tooth/structure identification
What you should expect in this role
* Must be a resident of the state of California.
* Hybrid work environment 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 office is located in the Roseville/Sacramento area.