Orthodontic Medicaid Specialist - Rock Dental Brands

Prior Responsibilities

• Manage the end-to-end prior authorization process for Medicaid orthodontic procedures, including accurate submission of clinical documentation and follow-ups.
• Proactively monitor and resolve Medicaid claim denials by performing root cause analysis and submitting timely appeals.
• Perform daily follow-ups on unpaid or underpaid Medicaid claims and utilize payer portals (e.g., MMIS, Atrezzo) to check claim status and verify eligibility.

A/R Operations & Follow-up

• Maintain detailed, accurate documentation in practice management software for all A/R activities and appeal statuses.
• Conduct internal audits to ensure billing accuracy, maintain strict adherence to Medicaid compliance standards, and support compliance and revenue integrity projects to identify and resolve recurring financial issues.

Collaboration & Reporting

• Collaborate with clinic staff to provide feedback on billing errors and audit A/R aging reports to identify trends in denials.

Qualifications

• Experience with dental Medicaid billing, prior authorizations, and the appeals process.
• Strong knowledge of dental terminology and CDT coding as it relates to Medicaid requirements.
• Proficient in practice management softwares and insurance portals.
• Excellent analytical and problem-solving skills with high attention to detail.

Key Competencies

• Operational excellence in Medicaid A/R management.
• Accountability and self-motivation.

Success Metrics

• Reduction in Medicaid denial rate.
• Timely authorization processing and reimbursement cycle.

Additional Notes

• This role requires high focus on payer portal management and clinical documentation standards.

What We Offer

• Flexible health insurance options.
• Complimentary orthodontic care for you and your family.
• Paid time off and paid holidays.
• Industry-leading 401(k) with company match.
• Career growth and internal advancement opportunities.
• Modern, supportive call center environment with strong leadership.