Dental Care Coordinator II

No one looks forward to managing a Workers' Compensation claim. It can be a complex, time-consuming and costly experience. You need a partner who understands the process and can provide the expertise and services you require every step of the way.

Provide file coordination and management of dental treatment of up to 250 files by facilitating dental treatment appointments, updating the client regarding anything that transpires on the file and obtaining the claim and clinical notes from the provider for each date of service for simple files, basic multi files, single tooth implants and low level special handling files.

* Schedules initial treatment appointment by calling the provider and claimant to schedule, faxing the provider authorization, and updating the client with the appointment information. * Updates the estimated To Be Scheduled (TBS) date by line Item for any unscheduled treatment (continuously updates and manages until the line item is scheduled). * Performs day prior, of, and after calls for each Date of Service (DOS) which includes phone calls to the provider and patient, and updates to the client. * Accurately links and un-links treatment line items in treatment appointments from the Plan of Treatment (POT) * Updates client again with the clinical status when clinical documentation is received from the provider. * Uses My SMILES Diary queues, ticklers, and notification features daily to efficiently manage the case load and keep the clients updated. * Enters new Plans of Treatment, requests pricing & clinical review. Once reviewed and priced, sends the authorization (with supporting documentation) to the client for approval and calls to explain the additional/change in treatment. * Handles any special payment arrangement with non-contracted providers including pre-pays and discounts/negotiations. * Responds to the financial team’s requests within 48 hrs. in an effort to process claims received. * Works all special reports distributed by a supervisor/manager. * Reviews and responds to any requests from clients, provider, claimant, or supervisor and performs necessary action steps within 48 hrs. * Consistently demonstrates a positive attitude and an overall commitment to excellence and is a team player. * Actively participates in continuous operational improvements. Specific activities include, but are not limited to, offering feedback to management related to process, working closely with provider development team to address provider issues, collaborating with financial team to improve efficiency and participates in training/mentorship initiatives * Is open to coaching and willing to find more efficient processes when applicable. * No more than 5% variance based upon file count of incorrect service status (open vs. closed) during any audit of care coordinators files. * Performs miscellaneous tasks and projects as assigned by management.

**Education/Experience:** * High School Diploma * Certified Dental Assistant with 3 years experience preferred **Knowledge, Skills and Other Abilities:** * Problem solving skills * Analytical skills * Research skills * Project management * Customer service * Case Management **Physical/Emotional Demands and Work Environment:** * For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear. * For roles located in the field; this job is primarily active; the employee is regularly mobile and must be able to utilize transportation (such as driving), sit, use hands and fingers, speak, and hear. * The employee is occasionally required to stand, walk, and lift objects (up to 10lbs weight; up to 4 ft. height). * Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus. * The work environment utilizes florescent lighting; noise level is moderate. * The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload. * Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position. * Please be advised the job description is subject to change at any time.