[Remote] Dental Access Referral Coordinator

Note: The job is a remote job and is open to candidates in USA. Bayside Solutions is seeking a Dental Access Referral Coordinator to manage dental referrals and provider relations. The role involves ensuring members are matched with suitable dental providers and providing support across various internal teams.

Responsibilities
• Receive and process referral requests and authorizations from members, primary care dentists, medical providers, and internal departments
• Review referral submissions for completeness and ensure all required documentation is obtained
• Facilitate referral requests and authorization determinations in accordance with established policies
• Provide referral assistance and guidance to members
• Monitor referral queue volumes daily and implement defined escalation processes as needed
• Build and maintain strong relationships with network providers to support timely referrals and appointment scheduling
• Serve as a subject matter expert on dental health benefits and provider network access
• Collaborate with members, providers, and internal departments to improve referral workflows and member experience
• Support provider recruitment, contracting, onboarding, and specialty provider engagement
• Train and onboard the dental provider office staff on our policies and procedures
• Maintain and update resources related to dental coding terminology, documented workflows, provider lists, and availability data
• Track and report general and specialty provider access metrics
• Identify, analyze, and escalate emerging access barriers and network trends to the Dental Benefits Manager

Skills
• Bachelor's degree in Business Administration, Health Care Administration, Social Sciences, or a related field required
• One (1) to three (3) years of experience in a clinical or healthcare setting
• Intermediate verbal and written communication skills
• Intermediate proficiency with personal computers and Microsoft Office Suite applications (Outlook, Word, Excel, Teams, PowerPoint)
• Intermediate meeting management and facilitation skills
• Basic knowledge of managed care principles and operations
• Working knowledge of provider and network operations
• Extensive knowledge of conflict resolution and process improvement principles
• Extensive knowledge of healthcare billing practices, preferably related to dental services
• Ability to work collaboratively and maintain cooperative working relationships
• Ability to adapt to changing priorities and requirements
• Ability to professionally represent the health plan in public and provider-facing settings
• Demonstrated ability to interpret complex regulations, analyze issues, and implement sound recommendations
• Ability to serve as a resource to others regarding relevant laws and regulations
• Dental referral management
• Referral processing and authorization
• Dental provider network access
• Provider relations management
• Care coordination support
• Customer support collaboration
• Claims and provider services coordination
• Healthcare workflow management
• Member assistance and guidance
• Referral queue monitoring and escalation
• Appointment scheduling coordination
• Dental benefits expertise
• Managed care principles
• Provider network operations
• Provider recruitment and onboarding
• Provider contracting support
• Specialty provider engagement
• Provider training and education
• Dental coding terminology
• Healthcare billing practices (dental)
• Documentation review and compliance
• Resource and workflow documentation
• Provider data and availability management
• Access metrics tracking and reporting
• Network access analysis
• Access barrier identification and escalation
• Process improvement
• Conflict resolution
• Cross-functional collaboration
• Regulatory interpretation and compliance
• Healthcare policy application
• Microsoft Office (Outlook, Word, Excel, Teams, PowerPoint)
• Meeting facilitation
• Verbal and written communication
• Data analysis
• Relationship building
• Adaptability to changing priorities
• Professional representation of health plans

Company Overview
• Bayside Solutions is a staffing and recruiting company offering IT, telecom, and scientific staffing services. It was founded in 2001, and is headquartered in San Ramon, California, USA, with a workforce of 51-200 employees. Its website is https://baysidesolutions.com/.

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