Dental Claims Coordinator - Orange - Astiva Health, Inc

    Astiva Health, Inc
    Astiva Health, Inc Orange

    10 hours ago

    Healthcare
    Description

    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: Astiva Health is seeking a full-time Claims Department staff member dedicated to dental affairs. This role supports accurate, timely dental claims processing, provider education, utilization review support, and dental grievance coordination. The position plays a key role in improving turnaround time, compliance, and provider experience for dental services.

    ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

    • 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
    • Assist providers in submitting clean claims and complete authorization requests
    • Educate dental providers and office staff on proper use of the Astiva Health online portal
    • Serve as a point of contact for common dental claims and portal-related questions
    • Preview of dental authorization request submissions on the provider portal
    • Identify red flags and utilization trends (e.g., high-frequency procedures, unusual billing patterns)
    • Assist with basic trend analysis and reporting for dental claims activity
    • Serve as the dental grievance coordinator
    • Dental Office Audit Support
    • Regular and consistent attendance
    • Other duties as assigned

    QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    EDUCATION and/or EXPERIENCE:

    • 4 year college degree or equivalent
    • Experience in dental claims processing, dental billing, or dental office administration preferred
    • Familiarity with CDT codes, dental documentation requirements, and dental prior authorizations
    • Experience working with payer portals or dental practice management systems 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
    • Detail-oriented with ability to identify trends and discrepancies

    OTHER SKILLS and ABILITIES:

    • Excel and Word

    BENEFITS:

    • Free Catered Lunches everyday
    • 401(k)
    • Dental Insurance
    • Health Insurance
    • Life Insurance
    • Vision Insurance
    • Paid Time Off
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