Orthodontic Medicaid Specialist - Rock Dental Brands

It's fun to work in a company where people truly BELIEVE in what they're doing!

We're committed to bringing passion and customer focus to the business.

Looking for a new career that impacts lives by creating smiles for a lifetime? Rock Dental Brands has an exciting opportunity for a talented and self-motivated individual to become a member of our team. The Orthodontic Medicaid Specialist is responsible for managing and overseeing the Medicaid accounts receivable (A/R) lifecycle for our dental clinics. This role specializes in handling the prior authorization submission and reconsideration process, aggressively following up on payment denials, managing complex appeals, and ensuring accurate payment posting to optimize reimbursement.

Core Responsibilities

Prior Authorization Management:

• Manage the end-to-end prior authorization process for Medicaid orthodontic procedures, including accurate submission of clinical documentation and follow-ups.

Denial & Appeals Management:

• Proactively monitor and resolve Medicaid claim denials by performing root cause analysis and submitting timely appeals.

A/R Operations & Follow-up:

• 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.

Compliance, Audits & Revenue Integrity:

• 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.