| Department: Clinical | FLSA: Varies by position |
| Reports to: Dental Manager | Approved Date: July 15, 2024 |
Summary:
Under the direction of the Dental Manager, the Dental Coordinator is responsible for coordinating all aspects of dental treatment plans, including incomplete plans, referrals, and prior authorizations. This role includes supporting all dental services, ensuring efficient communication, record-keeping, inventory control, and high-quality patient care. The Dental Coordinator will also assist in identifying issues with processes and help develop processes to ensure timely patient care and manage both internal and external referrals and prior authorizations.
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Essential Duties and Responsibilities:
- Communication: Conveys information accurately and efficiently. Written communication is direct, concise, and easy to understand. Ability to speak clearly and concisely.
- Decision-making: Gathers necessary information to make good and timely decisions. Uses sound judgment and instincts.
- Directing others/Delegation: Assesses other staff member abilities and provides coaching and recognition.
- Planning/Priority setting: Organizes tasks and objectives in order of importance, timing, and predicted results. Works within measurable goals and outcomes.
- Problem solving: Works systematically to solve problems. Develops reasonable and timely resolutions. Ability to make suggestions on workflow or systems.
- Initiative: Takes prompt action to accomplish objectives. Seeks to resolve problems without being asked.
KEY FUNCTIONS:
- Coordinate all aspects of incomplete treatment plans in a timely manner to ensure patients receive the care they need.
- Verify insurance coverage and obtain prior authorizations for services as required by individual insurance plans.
- Coordinate with the billing department and/or dental clinical staff as needed on prior authorizations, handle denied authorizations and ensure proper management of claims.
- Ensure task box is managed efficiently, answering questions from support center staff regarding dental patients.
- Communicate information and updates to patients and providers.
- Document care coordination, telephone calls, and other relevant clinical information in EHR.
- Assemble paperwork and requested medical information and submit to specialty offices as needed for referrals or other patient coordination efforts.
- Ensure specialists accept the patient’s insurance plan.
- Establish and maintain professional relationships with all staff, providing excellent customer service.
- Inform leadership of concerns, backlogs, or insurance issues.
- Correspond with dental staff to ensure effective communication and scheduling.
- Plan and manage the infection control plan to meet OSHA, CDC, and ADA standards.
- Support and assist with special community outreach care programs.
- Prepare and mail follow-up correspondence to parents or patients.
- Call/correspond with parents to schedule students/patients with healthcare needs for office or telehealth visits.
- Assist providers in ensuring all patient records and documents are accurately completed and filed.
- Maintain patient confidentiality at all times.
- If credentials allow, provide clinical coverage as needed to fill temporary gaps in staffing.
REFERRAL MANAGEMENT:- Document in the patient’s record the referral to specialty services, including the date of referral, name of the provider, and scheduled appointment date.
- Track dental specialty referrals using the Grace Health Referral Tracking process.
- Monitor the performance of specialty providers, ensuring quality care and removing any provider who does not meet standards.
- Establish formal or informal referral agreements with specialists.
- Manage referral agreements with specialists in more remote locations if local specialists are unavailable.
PRIOR AUTHORIZATION (PA):- Monitor treatment plans for services that require prior authorization, and initiate PA process according to Standard Operating Procedure (SOP).
- Work PA by collaborating with dental clinical and billing staff to (re)submit the required information.
- Communicate with patients and staff as necessary to move through the PA process and ensure the patient receives the treatment they need.
- Monitor in-progress PA requests to ensure timely documentation and follow-up.
OTHER SERVICE LINES:- Assist with coordination with schools to schedule patients, check eligibility and benefits, enter demographics, scan documents, or abstract data as needed.
Work with other entities to coordinate care with our clinic sites, such as scheduling appointments, coordinating paperwork, and communication with the entity for coordination of care, billing, and other needs.
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Other Essential Duties and Responsibilities:
- Grace Health recognizes that managing patient care is a team effort involving both clinical and non-clinical staff. All employees must embrace a team-based approach to patient care and understand that each role is important to our success.
- Team members must demonstrate excellent communication and coordination skills to provide quality patient care.
- Care coordination includes communication with community organizations, health plans, facilities, and specialists.
- Care team members must understand and embrace the concept of population health management and proactively address the needs of patients and families served by the practice.
- Team members must demonstrate the skills and knowledge necessary to communicate effectively with vulnerable patient populations.
- Team members must participate in Continuous Quality Improvement (CQI) activities within the organization to ensure patients receive high-quality care.
- All team members will be involved in improving quality outcomes.
- Team members will participate in the review and evaluation of practice performance and help identify opportunities for improvement.
- Team members will participate in Grace Health's advocacy program.
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General Duties:
- Follows all organizational policies and procedures, including administrative, clinical, quality assurance, and personnel policies.
- Maintains satisfactory attendance, including attendance at meetings and completion of assigned tasks.
- Maintains timely documentation of all work assignments.
- Maintains patient confidentiality.
- Routinely keeps the supervisor informed regarding attendance and job assignments.
- Demonstrates flexibility and the ability to multitask.
- Works effectively and efficiently.
- Works cooperatively with providers, administration, and peers.
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Qualification Requirements:
To perform this job successfully, an individual must be able to support and advance Grace Health's mission while satisfactorily performing each essential duty. The requirements listed below represent the knowledge, skills, and abilities required for the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
Skills:- Pleasant personality and professional demeanor.
- Cooperative attitude and flexibility.
- Detail-oriented with the ability to work with minimal supervision.
- Highly organized with the ability to prioritize tasks.
- Intermediate computer skills with Microsoft Word and Excel.
- Familiarity with Electronic Medical Records.
- Strong communication, decision-making, and problem-solving skills.
- Ability to manage multiple tasks and maintain professional relationships
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Education and/or Experience: - High school diploma or equivalent required.
- Experience with dental services, referrals and authorizations preferred.
- At least 1 year of dental office experience preferred.
- Basic Life Support (BLS) certification required.
- Participation in continued education.
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Physical Demands:
The physical demands described herein represent those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand, walk, sit, and use hands to finger, handle, or feel objects, tools, or controls. The employee occasionally is required to reach with hands and arms, stoop, kneel, crouch, or crawl, and taste or smell.
The employee must occasionally lift and /or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
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Work Environment:
Grace Health is a faith-based, federally qualified health center (FQHC). We provide primary healthcare services to underserved, underinsured, and uninsured individuals throughout southeastern Kentucky. Our mission is "to show the love and share the truth of Jesus Christ to southeastern Kentucky through access to compassionate, high-quality primary healthcare for the whole person."
The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position.
The noise level in the work environment is typically moderate.
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