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 Support
- Process and review dental paper claims for completeness and accuracy
- Request missing documentation (e.g., X-rays, narratives, periodontal charting) to ensure timely claims adjudication
- Track and follow up on outstanding documentation to meet regulatory turnaround timelines
- Assist in dental claims check run report
Provider Relations Support
- Assist dental providers and office staff on proper use of the Astiva Health online portal
- Assist providers in submitting clean claims and complete authorization requests
- Assist PR staff with common dental claims and portal-related questions
Authorization & Pre-Review Support
- Preview dental prior authorization submissions on the provider portal
- Identify missing documentation or administrative deficiencies prior to formal review
- Flag incomplete or non-compliant submissions to reduce delays and denials
- Escalate complex or high dollar claims to senior coordinators
Member Services Support
- Assist MS team with dental related issues
- Adjudicate member direct reimbursement and escalate complex, high dollar cases to senior coordinators
EDUCATION and/or EXPERIENCE:
- Experience in dental claims processing, dental billing, or dental office administration experience preferred
- Familiarity with CDT codes, dental documentation requirements, and dental prior authorizations
- Experience working with payer portals or dental practice management systems experience preferred
- Strong organizational, communication, and follow-up skills
- Detail-oriented with ability to identify trends and discrepancies
- Medicare Advantage or managed care experience a plus
BENEFITS:
- 401(k)
- Dental Insurance
- Health Insurance
- Life Insurance
- Vision Insurance
- Paid Time Off
- Free lunch onsite