[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/. Apply Now Apply Now