ACCESS Provider Services Specialist

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🕒 6 dias atrás

🌲 North Carolina – Remoto

🌲 North Carolina – Remote

💵 $42.000 - $65.000 / ano

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

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Vaya Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 1972

🛡️ Seguros

💼 Consultoria

📦 Logística

Insurance • Consulting • Logistics

A Vaya Health é uma organização sediada na Carolina do Norte que gerencia serviços para indivíduos com problemas de saúde comportamental, incluindo transtornos mentais e de uso de substâncias, deficiências intelectuais e de desenvolvimento (I/DD) e lesões cerebrais traumáticas (TBI). A organização fornece serviços de Medicaid personalizados para essas populações, com foco em uma abordagem centrada na pessoa que conecta os membros ao cuidado e suporte necessário para seus objetivos únicos de saúde e bem-estar. A Vaya Health enfatiza a colaboração em várias áreas de cuidado para garantir apoio abrangente aos seus membros, promovendo comunidades mais saudáveis em toda a região.

Descrição

• Assist network providers with inquiries related to claims, contracts, authorizations, benefits, services, registries, and community resources • Screen, handle, and route incoming phone calls, aiming for first-call resolution • Initiate outbound calls based on established work queues, lists, and assignments • Document all calls and routing activities through defined workflows and processes • Provide information and respond to providers’ inquiries, concerns, and questions by phone • Perform initial triage of callers’ needs and determine appropriate call handling • Educate providers about resources available through Provider Central • Provide navigation support for forms, training guides, and contracting information • Authenticate providers, identify needs, and connect callers to the appropriate One Touch workgroup • Serve as liaison between departments regarding questions, processes, and information resources • Update materials related to call center operations when assigned • Serve as a subject matter expert for Provider Support Line call center operations • Complete progress notes, forms, reports, and other required documentation at the time of the call and by the end of the workday or shift • Assist with specialized ACCESS Call Center departmental projects and reviews as requested by management • Perform other duties as assigned

🎯 Requisitos

• Bachelor’s degree in a Human Services field and at least two years of experience working with adults or children with serious psychiatric, chemical dependence, or developmental disability in a community mental health center or similar setting; OR bachelor’s degree from an accredited college or university and at least four years of comparable experience • Must be qualified as a Qualified Professional according to 10A NCAC 27G .0104 • Must reside in North Carolina or within 40 miles of the North Carolina border • Considerable knowledge of the MH/SU/DD service array provided through the network of Vaya Partners providers • Knowledge of Medicaid 1115, Medicaid B and C waivers, and Vaya Partners accreditation requirements • Understanding of BH I/DD Tailored Plan eligibility, services, policies, procedures, and Provider Manual requirements • Ability to handle confidential healthcare information and protected health information (PHI), comply with HIPAA and related confidentiality laws, complete required confidentiality training, and sign a confidentiality statement • High level of diplomacy and discretion • Exceptional interpersonal and communication skills • Prompt independent decision-making, problem solving, negotiation, arbitration, and conflict resolution skills • Ability to organize multiple tasks and priorities and manage projects from start to finish • Ability to adapt to changing priorities • Close visual acuity and ability to perform sedentary work, sit for extended periods, and lift up to 10 pounds • Preferred: 2+ years of experience in a network management-related role handling complex network providers in the health care industry

🏖️ Benefícios

• Monday–Friday work schedule, 9:30 am–6:00 pm • 40-hour work week • Overtime compensation eligibility • Remote, home-based virtual position • Holiday rotation as required by the business