Junior Dental Coordinator in Orange, California at Astiva Health

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

BENEFITS:

• 401(k)
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off

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:

• 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

LANGUAGE: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups and customers or employees of the organization.

MATHEMATICS: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

EEO/AFFIRMATIVE ACTION STATEMENT: It is the policy of Astiva Health to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. This policy relates to all phases of employment, including but not limited to recruiting, employment, placement, promotion, transfer, demotion, reduction of workforce and termination, rates of pay or other forms of compensation, selection for training, the use of all facilities, and participation in all company sponsored employee activities. Provisions in applicable laws providing for bona fide occupational qualifications, business necessity or age limitations will be adhered to by the organization where appropriate. Please refer to Standard Operating Procedure 100 for more information about the organization’s Affirmative Action/EEO statement.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit and complete work while on a computer. The employee occasionally is required to stand, walk, use hands to finger, handle or feel, reach with hands and arms, stoop, kneel, crouch or crawl, climb or balance, talk and hear.

While performing the duties of this job, the employee is occasionally required to lift or exert force up to 10 pounds.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate