ROLE OVERVIEW The Pre-Authorization & Billing Specialist plays a dual role in the Revenue Cycle Management (RCM) department by ensuring timely and accurate pre-authorizations for procedures and submitting clean claims fo…
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Full-time
Medical insurance, Dental insurance, Vision insurance, Virtual care, Employee assistance program, Bonus opportunities
Posted 10d ago
~40 hrs/week
Responsibilities
The specialist manages pre-authorizations for procedures and ensures the submission of accurate, compliant insurance claims. They act as a liaison between clinical teams and payers to maximize revenue and resolve billing discrepancies.
Requirements
Candidates must have prior experience in dental office revenue cycle functions and proficiency in billing software and coding standards. Strong knowledge of insurance plans, compliance regulations, and excellent communication skills are required.
Full job description
ROLE OVERVIEW
The Pre-Authorization & Billing Specialist plays a dual role in the Revenue Cycle Management (RCM) department by ensuring timely and accurate pre-authorizations for procedures and submitting clean claims for reimbursement. This role serves as a key link between clinical operations, insurance payers, and the billing team to help maximize revenue, reduce denials, and maintain compliance.
KEY RESPONSIBILITIES
Submit timely and complete pre-authorization requests to insurance payers with supporting documentation (clinical notes, X-rays, narratives).
Track authorization statuses, follow up on pending requests, and escalate delays as needed.
Maintain detailed logs of approval/denial statuses, including authorization numbers and expiration dates.
Communicate authorization updates to clinical and front office teams in a timely manner.
Stay current with payer-specific pre-auth requirements and documentation rules.
Submit accurate, compliant claims using proper CDT, CPT, and ICD-10 coding.
Resolve claim edits and rejections in clearinghouse or EHR system.
Coordinate with insurance verification and AR teams to ensure all claim data is correct.
Ensure claims are submitted within payer timely filing deadlines.
Document claim actions in patient accounts for visibility and continuity.
Partner with pre-authorization and AR follow-up teams to avoid billing delays.
Escalate denials, trends, or payer policy updates to leadership.
Maintain compliance with HIPAA, payer regulations, and company SOPs.
Participate in training, audits, and process improvement initiatives as needed.
Essential Qualifications
Prior experience in dental office revenue cycle functions, with expertise in:
Scheduling & Registration – Understanding patient flow and eligibility verification.
Insurance Verification – Confirming coverage, benefits, and policy limitations.
Fee Schedules & Charging/Coding – Ensuring accurate claim submission using CDT, CPT, and ICD-10 codes.
Claim Submission & Follow-Up – Knowledge of clean claim processing, payer-specific requirements, and handling rejections/denials.
Strong knowledge of reimbursement & compliance processes for:
Medicare, Medicaid, PPO, HMO, and Fee-for-Service (FFS) plans
Payer guidelines, coordination of benefits (COB), and timely filing limits
Insurance dispute resolution and appeal submission best practices
Proficiency in dental billing software & industry tools:
Practice Management Systems (PMS): CareStack, WinOMS, OMSVision, Dentrix, Eaglesoft, etc.
Insurance Portals & Clearinghouses: Working with Navinet, Availity, Change Healthcare, and payer-specific platforms
Microsoft Office Suite:
Strong computer literacy.
Strong interpersonal and organizational skills to work effectively within a team and independently.
Excellent oral and written communication skills, particularly in handling payer escalations and patient billing inquiries.
Demonstrates attention to detail, accuracy, and analytical thinking in identifying claim discrepancies.
Accountable for quality work, meeting deadlines, and adhering to RCM compliance and SOPs.
What We Offer:
Core Benefits & Wellness
Comprehensive Medical, Dental & Vision Insurance (Virtual Care included)
Confidential Employee Assistance Program (EAP) for you and your family
Financial Wellness
Competitive Pay with Bonus Opportunities & Annual Merit Increases
401(k) Retirement Plan with Company Match
Health Savings Account (HSA) options with HDHP plans
Life Insurance Protection
Company-Paid Basic Life Insurance
Optional Supplemental Life Coverage for You, Your Spouse & Children
As trusted partners to the dentists and communities we serve, our teams strive to put the needs of our patients first.
Industry
Hospitals and Health Care
Company size
201-500 employees
Founded
2019
Headquarters
Lincoln, NE
LinkedIn followers
5,689
Paradigm Oral Health is dedicated to providing clinically excellent, patient focused oral health care with exceptional outcomes. Paradigm’s uniqueness comes from their ability to hire the most elite oral surgeons in the country and train them on their proprietary platform of excellence.
How much do Administrative jobs in California pay?
Based on 5726 listings with disclosed salaries, most administrative jobs in California pay between $65k–$128k per year. Individual offers vary with seniority, company size, and specialization.
How many Administrative jobs are open in California right now?
There are currently 26,151 open administrative positions in California listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Administrative roles in California?
Companies currently hiring include Costco Wholesale, UCSF Department of Anesthesia and Perioperative Care, Adventist Health Sierra Vista, Keck Medicine of USC, Sutter Health, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Administrative jobs in California?
Yes — 3999 of the 26151 open administrative positions offer remote or hybrid work (1088 remote, 2911 hybrid).
How do I apply for Administrative jobs in California?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.