Dental Claims Coordinator

POSITION PURPOSE

This position is responsible for providing claims coordination activities for partnering private practice dental offices within the guidelines of the Ontario Seniors Dental Care Program (OSDCP), Service Level Agreements (SLAs), as well as internal policies and procedures. Receives, reviews and processes Dental Claims and pre-determinations, ensuring submissions meet OSDCP guidelines and contract conditions. Provides other administrative duties to support the private practice program, including supporting process improvement initiatives. This position is the first point-of-contact for partnering private practice dental offices who need support with the OSDCP claims process.

MAJOR RESPONSIBILITIES

• Processes paper or electronically submitted Dental Claims and pre-determination inquiries from partnering private practice dental offices according to program guidelines, ensuring timely submission and accurate documentation, while maintaining the confidentiality of claims information.
• Reviews submitted claims documentation to verify eligibility of claims and adjudicates claims according to contract provisions and program guidelines and policies.
• Prepares straightforward correspondence outlining decision of claims adjudication.
• Consults with the internal dental team or Manager regarding complex Dental Claims that require further review and escalates as appropriate.
• Identifies discrepancies with SLAs and escalates to management for investigation.
• Responds to dental office inquiries and provides accurate information regarding dental services offered, and program policies.
• Creates, organizes, maintains and tracks client files and records in accordance with Regional standards and systems.
• Keeps current with new developments in clinical procedures, dental practice processes and workflows.
• Responds to inquiries and resolves concerns, as appropriate.
• Ensures that services provided meet Regional customer service standards.
• Participates on work groups and projects, as assigned.
• Handles information in accordance with legislation and corporate standards.
• Performs other duties as assigned, in accordance with Branch and Department objectives.

QUALIFICATIONS

• Successful completion of a high school diploma and post-secondary dental-related certification, or related field, or approved equivalent combination of education and experience.
• Minimum three (3) years of dental administration experience, dental experience, or dental adjudication or claims experience.
• Satisfactory Vulnerable Sector Check.
• Knowledge of current dental laboratory and clinical procedures, dental practice processes and workflows.
• Knowledge of the relevant dental programs.
• Excellent organizational skills and strong attention to detail.
• Written and verbal communication skills and demonstrated ability to clearly and accurately convey information.
• Demonstrated ability in the Region’s core competencies.