Dental Coverage & Authorization Specialist

Western-Wayne-Family-Health-Centers-1; Dearborn (MI); On-site; USD 25,000 - 39,000; Full time

Job summary

Western Wayne Family Health Centers is seeking a detail-oriented Pre-Authorization and Insurance Specialist to verify eligibility, benefits, and treatment history for dental procedures. You will coordinate referrals and coverage determinations, interact with insurance entities, and ensure timely submission of documentation.

This role requires familiarity with EHRs (IDentalSoft, Athena, EPIC), strong communication, and adherence to HIPAA/privacy policies.

Qualifications

• High School Diploma or equivalent.
• Two years of experience in a dental support, pre-authorization, insurance coordination, or related healthcare role.
• Knowledge of insurance verification, authorization processes, and payer guidelines.
• Proficiency with electronic health records and documentation standards.
• Ability to maintain patient confidentiality and HIPAA compliance.

Responsibilities

• Verify insurance eligibility, benefits, and frequency limits prior to procedures.
• Prepare and submit referrals, authorizations, pretreatment estimates, and precertifications.
• Communicate determination status to providers, staff, and patients as needed.
• Track and update requests to prevent coverage gaps and delays in care.
• Follow up on denials and coordinate with billing staff for appeals.
• Maintain accurate EHR documentation and ensure data integrity.

Skills

Insurance verification

Payer guidelines

Analytical skills

Communication

HIPAA compliance

Time management

Education

High School Diploma

Tools

IDentalSoft

Athena

EPIC

Job description

Western Wayne Family Health Centers is seeking a detail-oriented Pre-Authorization and Insurance Specialist to verify eligibility, benefits, and treatment history for dental procedures. You will coordinate referrals and coverage determinations, interact with insurance entities, and ensure timely submission of documentation.

This role requires familiarity with EHRs (IDentalSoft, Athena, EPIC), strong communication, and adherence to HIPAA/privacy policies.