Dental Assistant or Hygienist - Remote

Title: Dental Assistant/Hygienist - Remote Shift: 8am-5pm, Monday-Friday Description: Evaluate dental claims, adjustments, and prior authorization requests against Medi-Cal Dental criteria. Generate requests to dental providers for missing claims information. Confirm that claims documentation is complete, and complies with policy, and refer documents to dental professionals when required. Monitor members actively receiving appropriate care/scheduled care and ensure they complete their goals. Maintain and record decisions, actions, and outcomes for members receiving care coordination. Set up tasks, reminders, and follow-ups on missed appointments What we're looking for: Graduate from an accredited dental assistant school or two (2) years of prior experience working in a dental office (dental assistant, registered dental assistant, registered dental hygienist, etc). Two (2) years prior experience in a dental billing and claims processing environment. Expertise to support treatment authorization requests (TAR) and claims adjudication, including familiarity with principles of dental radiography, such as orientation and tooth/structure identification. Your role in our mission: Evaluate dental claims, adjustments, and prior authorization requests against Medi-Cal Dental criteria. Generate requests to dental providers for missing claims information. Confirm that claims documentation is complete, and complies with policy, and refer documents to dental professionals when required. Monitor members actively receiving appropriate care/scheduled care and ensure they complete their goals. Maintain and record decisions, actions, and outcomes for members receiving care coordination. Set up tasks, reminders, and follow-ups on missed appointments