ACCESS Provider Services Specialist

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🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $42k - $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

• 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

🎯 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 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

🏖️ Benefits

• 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