Jr Dental Claims Coordinator
About Us:Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.SUMMARY: The Junior Dental Coordinator role assists with dental claims processing, provider support, and authorization review to ensure accurate and timely adjudication. This position reviews claims for completeness, follows up on required documentation, supports providers with portal use and clean submissions, and helps identify and resolve issues prior to formal review. The role also supports member services with dental-related inquiries and reimbursements, escalating complex cases as needed.ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:Dental Claims Operations SupportProcess and review dental paper claims for completeness and accuracyRequest missing documentation (e.g., X-rays, narratives, periodontal charting) to ensure timely claims adjudicationTrack and follow up on outstanding documentation to meet regulatory turnaround timelinesAssist in dental claims check run reportProvider Relations SupportAssist dental providers and office staff on proper use of the Astiva Health online portalAssist providers in submitting clean claims and complete authorization requestsAssist PR staff with common dental claims and portal-related questionsAuthorization & Pre-Review SupportPreview dental prior authorization submissions on the provider portalIdentify missing documentation or administrative deficiencies prior to formal reviewFlag incomplete or non-compliant submissions to reduce delays and denialsEscalate complex or high dollar claims to senior coordinatorsMember Services SupportAssist MS team with dental related issuesAdjudicate member direct reimbursement and escalate complex, high dollar cases to senior coordinatorsEDUCATION and/or EXPERIENCE:Experience in dental claims processing, dental billing, or dental office administration experience preferredFamiliarity with CDT codes, dental documentation requirements, and dental prior authorizationsExperience working with payer portals or dental practice management systems experience preferredStrong organizational, communication, and follow-up skillsDetail-oriented with ability to identify trends and discrepanciesMedicare Advantage or managed care experience a plusBENEFITS:401(k)Dental InsuranceHealth InsuranceLife InsuranceVision InsurancePaid Time OffFree lunch onsite