SUMMARY

The Dental Insurance Verification & Authorization Specialist is a part-time position within the dental department of Squirrel Hill Health Center. This role is primarily responsible for verifying patient dental insurance eligibility, obtaining prior authorizations for scheduled procedures, and maintaining accurate insurance and authorization records in the practice management system. The position also serves as a trained backup to the full-time Dental Front Office Coordinator, ensuring continuity of front desk operations during absences and periods of high patient volume. The incumbent must have working knowledge of dental benefit structures, FQHC sliding fee program requirements, and HIPAA compliance obligations and must demonstrate the values consistent with the Squirrel Hill Health Center’s mission.

ESSENTIAL FUNCTIONS

Insurance Verification & Prior Authorization (approximately 80%)

• Verify dental insurance eligibility for all scheduled patients in advance of appointments via payer portals, telephone verification, and/or EDI transactions.
• Confirm and document benefit details including annual maximums, deductibles, co-insurance, frequencies, waiting periods, missing tooth clauses, and covered procedure categories.
• Obtain prior authorizations and predeterminations for procedures requiring payer approval, including but not limited to crowns, extractions, periodontal treatment, and orthodontics.
• Monitor authorization status, follow up on pending requests, and communicate approval or denial outcomes promptly to clinical staff and, as appropriate, to patients.
• Accurately enter and maintain patient insurance information, eligibility findings, and authorization documentation in the dental practice management system.
• Coordinate with billing staff to ensure insurance information is complete and verified prior to claim submission.
• Identify patients with limited or no dental coverage and refer appropriately for sliding fee discount program screening in accordance with FQHC policy.
• Maintain current working knowledge of Medicaid dental (PA DHS), CHIP, Medicare Advantage dental riders, and commercial dental benefit plans.
• Document all verification and authorization activity in accordance with department protocols and retention requirements.

Dental Front Office Backup (approximately 20%)

• Serve as the designated backup to the full-time Dental Front Office Coordinator during scheduled and unscheduled absences and periods of high patient volume.
• Perform patient check-in and check-out, including collection of copays and patient balances per FQHC financial policy.
• Schedule and confirm patient appointments; assist with dental recall system management as directed.
• Answer dental department phone lines, triage inquiries, and route messages to the appropriate staff.
• Prepare and distribute daily schedules and encounter documentation packets for the clinical team.

OTHER RESPONSIBILITIES INCLUDE

1.  Collect and stamp outgoing dental mail.
2. Collect, stamp as received and distribute all incoming dental mail to appropriate recipients: no mail is to be opened before distribution to intended recipient.
3. Collect faxes, send faxes, and distribute faxes to appropriate recipients.
4. Ensure that all front areas, front office and waiting area, are neat at all times; personal work areas must be kept professional and well organized at all times.
5. Maintain confidentiality and is compliant with HIPAA.
6. Available and willing to work in any SHHC location as needed
7. Perform other duties as assigned by the Dental Office Manager.

CORE COMPETENCIES

• Patient-Centered Service – Demonstrates courtesy, empathy, and cultural humility in all patient interactions.
• Accuracy & Attention to Detail – Produces consistent, error-free work in a deadline-driven environment.
• Adaptability – Transitions effectively between insurance verification work and front desk coverage responsibilities.
• Communication – Conveys information clearly and professionally in both written and verbal form.
• Confidentiality & Compliance – Adheres strictly to HIPAA requirements and all applicable organizational privacy and security policies.
• Team Collaboration – Works cooperatively with dental clinical staff, billing personnel, and the broader care team.

QUALIFICATIONS

Required

• High school diploma or GED equivalent.
• Minimum of one (1) year of experience in dental insurance verification, prior authorizations, or dental front office operations.
• Demonstrated knowledge of CDT procedure codes and dental benefit plan structures.
• Proficiency with dental practice management software and electronic health records.
• Strong attention to detail and ability to manage multiple competing priorities in a fast-paced environment.
• Professional communication skills, both verbal and written, with patients and payer representatives.
• Working knowledge of HIPAA Privacy and Security requirements as they apply to protected health information.

Preferred

• Prior experience in a Federally Qualified Health Center or safety-net dental setting.
• Familiarity with Pennsylvania Medicaid Dental (PA DHS) and CHIP dental benefit programs.
• Experience with FQHC sliding fee discount programs and income-based fee schedules.
• Bilingual or multilingual capability reflecting the languages of the patient population served.
• All AMA recommended vaccinations as required by SHHC

.WORKING CONDITIONS

Office and dental clinical environment; requires extended periods of sitting and use of computer and telephone.

• Regular interaction with patients who may present with language barriers, behavioral health needs, or complex social determinants of health.
• Schedule flexibility may be required to align with dental clinic hours or to provide front office coverage as needed.
• May require occasional cross-site coverage if the organization operates multiple dental locations.