Dental Claims Coordinator

Astiva Health, Inc; Orange (CA); On-site; USD 50,000 - 70,000; Full time

Job summary

A premier healthcare provider is seeking a full-time staff member for its Claims Department dedicated to dental affairs. The role involves processing dental claims, educating providers on the online portal, and ensuring timely adjudication. Ideal candidates should possess a college degree and familiarity with CDT codes, along with strong organizational and communication skills. Experience with payer portals and managed care is preferred. This position is essential for improving compliance and provider experience in dental services.

Qualifications

• Familiarity with CDT codes and dental documentation requirements.
• Experience with dental prior authorizations is preferred.
• Medicare Advantage or managed care experience is a plus.

Responsibilities

• Process and review dental paper claims for completeness and accuracy.
• Request missing documentation to ensure timely claims adjudication.
• Assist providers in submitting clean claims.

Skills

Strong organizational skills

Communication skills

Follow-up skills

Detail-oriented

Education

4 year college degree or equivalent

Tools

Payer portals

Dental practice management systems

Job description

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

Astiva Health is seeking a full‑time Claims Department staff member dedicated to dental affairs. This role supports accurate, timely dental claims processing, provider education, utilization review support, and dental grievance coordination. The position plays a key role in improving turnaround time, compliance, and provider experience for dental services.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• 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
• Assist providers in submitting clean claims and complete authorization requests
• Educate dental providers and office staff on proper use of the Astiva Health online portal
• Serve as a point of contact for common dental claims and portal‑related questions
• Preview of dental authorization request submissions on the provider portal
• Identify red flags and utilization trends (e.g., high‑frequency procedures, unusual billing patterns)
• Assist with basic trend analysis and reporting for dental claims activity
• Serve as the dental grievance coordinator
• Dental Office Audit Support
• Regular and consistent attendance
• Other duties as assigned

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

• 4 year college degree or equivalent
• Familiarity with CDT codes, dental documentation requirements, and dental prior authorizations
• Experience working with payer portals or dental practice management systems 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
• Detail‑oriented with ability to identify trends and discrepancies