Telephone Inquiry Specialist

Wollborg Michelson Recruiting; Rancho Cordova (CA); On-site; USD 30,000 - 50,000; Full time

Job summary

Wollborg Michelson Recruiting is seeking a dental auditor/benefits specialist to handle complex beneficiary and provider inquiries, resolving issues, and processing related documents. The role requires knowledge of dental billing procedures, claims, and authorization processes, with the ability to navigate multiple computer systems and maintain confidentiality.

The ideal candidate has at least one year of communication experience, familiarity with dental terminology, and the ability to manage

Qualifications

• Pass the required dental auditor and X-ray reading tests.
• At least one year of communication experience.
• Knowledge of dental provider billing procedures and claims adjudication processes.
• Knowledge of applicable healthcare rules, dental codes, procedures, and practices is preferred.
• Knowledge of dental anatomy, physiology, pathology, and office terminology.
• Ability to perform detailed work, maintain confidentiality, and manage multiple concurrent tasks.

Responsibilities

• Research, resolve, and respond to complex telephone inquiries that cannot be answered immediately.
• Monitor cycle time reports and process documents, including customer information forms, notices of action, claims, treatment authorization requests, and related documents.
• Respond to beneficiary and representative inquiries regarding program policies, screening appointments, treatment authorization notifications, complaints, provider referrals, and available resources.
• Schedule and reschedule regional screening appointments as needed.
• Track beneficiary inquiries in the appropriate correspondence tracking system.
• Respond to provider office inquiries regarding program policies, claims and treatment authorization processing, explanations of benefits, payment inquiries, patient history, and enrollment status.
• Track provider inquiries in the appropriate correspondence tracking system.
• Complete additional projects and duties as assigned.

Skills

Customer service

Customer-focused communication

Telephone inquiry management

Research and problem-solving

Claims and authorization processing

Computer and multiple-systemNavigation

Detailed recordkeeping

Confidentiality and professionalism

Stress management and multitasking

Education

Dental assisting education

Job description

Job Summary

Handles complex telephone inquiries from beneficiaries, representatives, and provider offices; researches and resolves issues, processes related documents, tracks correspondence, and provides accurate information regarding dental programs, claims, authorizations, appointments, and provider services.

Responsibilities

• Research, resolve, and respond to complex telephone inquiries that cannot be answered immediately.
• Monitor cycle time reports and process documents, including customer information forms, notices of action, claims, treatment authorization requests, and related documents.
• Respond to beneficiary and representative inquiries regarding program policies, screening appointments, treatment authorization notifications, complaints, provider referrals, and available resources.
• Schedule and reschedule regional screening appointments as needed.
• Track beneficiary inquiries in the appropriate correspondence tracking system.
• Respond to provider office inquiries regarding program policies, claims and treatment authorization processing, explanations of benefits, payment inquiries, patient history, and enrollment status.
• Track provider inquiries in the appropriate correspondence tracking system.
• Complete additional projects and duties as assigned.

Requirements

• Pass the required dental auditor and X-ray reading tests.
• At least one year of communication experience.
• Knowledge of dental provider billing procedures and claims adjudication processes.
• Knowledge of applicable healthcare rules and regulations, dental codes, procedures, and practices is preferred.
• Knowledge of dental anatomy, physiology, pathology, and office terminology.
• Ability to perform detailed work, maintain confidentiality, and manage multiple concurrent tasks.
• Ability to handle frequent interruptions and manage stress effectively.
• Strong reasoning, problem-solving, basic math, and computer skills.
• Strong customer contact and communication skills.
• Ability to work overtime when required.

Skill

• Customer service and customer-focused communication
• Telephone inquiry management
• Research and problem-solving
• Claims and authorization processing
• Computer and multiple-system navigation
• Detailed recordkeeping
• Confidentiality and professionalism
• Stress management and multitasking

Summary Qualification

• Experienced in handling complex customer and provider inquiries.
• Knowledgeable in dental terminology, billing procedures, claims, and authorization processes.
• Skilled in communication, problem-solving, documentation, and customer service.
• Comfortable learning and navigating multiple computer systems.
• Demonstrates accuracy, confidentiality, professionalism, and sound judgment.
• Dental assisting education or at least two years of dental assisting experience is preferred.

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based on one s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.