ACCESS Member Services Specialist

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🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $54k - $65k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Vaya Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1972

🛡️ Insurance

💼 Consulting

📦 Logistics

Insurance • Consulting • Logistics

Vaya Health is a North Carolina-based organization that manages services for individuals with behavioral health issues, including mental health and substance use disorders, intellectual and developmental disabilities (I/DD), and traumatic brain injuries (TBI). The organization provides Medicaid services tailored for these populations, focusing on a person-centered approach that connects members to the necessary care and support for their unique health and wellness goals. Vaya Health emphasizes collaboration across various care areas to ensure comprehensive support for its members, fostering healthier communities across the region.

📋 Description

• Conduct telephonic screenings and collect demographic information • Review and confirm member and recipient eligibility • Offer provider choices based on consumer requests and service needs • Schedule appointments within established access time standards • Link members with contracted providers for clinical assessments • Identify risk indicators and make immediate referrals to Member and Recipient Services Clinicians • Handle customer service calls regarding enrollment, services, referrals, provider changes, Social Determinants of Health needs, and general information • Provide information about Vaya Partners, its provider network, community resources, and North Carolina Medicaid services • Complete warm transfers and link callers to appropriate parties, providers, vendors, community organizations, and legal guardians • Document call notes, forms, reports, and other required information in electronic systems • Report service-system gaps and needs to managers or Provider Network Development staff • Offer Customer Satisfaction Surveys and adhere to the NCMT Call Grading Rubric • Assist with specialized ACCESS Call Center projects and perform other assigned duties

🎯 Requirements

• 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 a Bachelor’s degree from an accredited college or university and at least four years of such experience • Must be qualified as a Qualified Professional according to 10A NCAC 27G .0104 • Experience providing mental health, substance abuse services, or intellectual/developmental disabilities • Knowledge of social work principles, techniques, and practices • Knowledge of behavioral health principles and complex treatment and service provision • Knowledge of person-centered and recovery philosophies • Familiarity with mental health, developmental disability, and substance abuse disorders • Knowledge of North Carolina’s Medicaid system • Knowledge of laws, regulations, and policies governing human services and utilization management • Ability to use complex telephone and computer systems and multiple technology systems concurrently during live calls • Ability to document information electronically and complete required documentation at the time of the call • Ability to communicate clearly orally and in writing • Ability to interact professionally with upset or disagreeing individuals • Must reside in North Carolina or within 40 miles of the North Carolina border

🏖️ Benefits

• Overtime compensation eligibility • Extensive training on customer service skills, insurance plans, applicable confidentiality laws, and related systems • Equal opportunity employer