ACCESS Provider Services Specialist (Mon-Fri, Remote NC)

LOCATION: Remote – this is a home based, virtual position. The person in this position must maintain residency in North Carolina or within 40 miles of the NC border.

Work Schedule: Monday – Friday from 9:30 am – 6:00 pm. This is a 40 hour per week position.

GENERAL STATEMENT OF JOB

The ACCESS Provider Services Specialist is responsible for assisting providers with inquiries related to claims, contracts, authorizations, benefits, services, registries, and community resources. ACCESS Provider Services Specialist provides appropriate screening, handling and routing of incoming phone calls with the goal to provide first call resolution when possible. ACCESS Provider Services Specialists are trained in specific functional areas for provider services and are also trained to handle overall inquiries and provide high quality customer service. The role may also initiate outbound calls per established work queues, lists and assignments. The ACCESS Provider Services Specialist is responsible for documentation of all calls and routing activities for follow up through defined workflows and processes. This job is subject to working holidays and holiday rotation as deemed necessary by the business.

Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Partners. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Partners.

ESSENTIAL JOB FUNCTIONS

Handle telephonic requests for assistance from network providers or potential network providers:

• Interacts by phone with providers to provide information in response to inquiries, concerns, and questions
• Performs initial triage of callers needs to determine appropriate handling of the call
• Interact with providers to provide information in response to inquiries about services and other resources
• Educates providers on resources available to providers on Provider Central
• Provides navigational support to frequently used forms, training guides, and information related to contracting with Vaya Partners
• Authenticate providers, identify needs and connect callers to the appropriate One Touch workgroup for assistance. This includes, but is not limited to, inquiries related to claims, billing, authorizations, contracting, and credentialing.
• Liaison between various departments to address questions and provide basic information about Vaya Partners, including processes and where to find information
• May be assigned responsibility for updating materials related to call center operation
• Serves as a subject matter expert for Provider Support Line call center operations

Documentation in the electronic information system:

The ACCESS Provider Services Specialist will complete progress notes, forms, reports and other documentation as required. The ACCESS Provider Services Specialist will complete required documentation at the time of call. All documentation must be complete at the end of the workday or shift.

Specialized projects and reviews:

The ACCESS Provider Services Specialist will assist in specialized ACCESS Call Center Departmental projects as requested by the ACCESS Provider Services Manager, ACCESS Director, Senior Director of ACCESS Call Center, and/or Vice President of Member Services.

Other duties:

Other duties as assigned.

KNOWLEDGE, SKILLS, & ABILITIES

A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. This will require exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts. Problem solving, negotiation, arbitration and conflict resolution skills are essential to balance the needs of both internal and external customers. Must be highly skilled at shifting between macro and micro level planning, maintaining both the big picture and seeing that the details are covered.

ACCESS Provider Services Specialist must have considerable knowledge of the MH/SU/DD service array provided through the network of Vaya Partners providers. Additional knowledge in Medicaid 1115, Medicaid B and C waivers and Vaya Partners accreditation requirements is essential.

The employee must be detail oriented, able to organize multiple tasks and priorities, and to effectively manage projects from start to finish. Work activities quickly change according to mandated changes and changing priorities within the department. The employee must be able to change the focus of his/her activities to meet changing priorities.

Training, learning and proficiency are tracked through the ACCESS Provider Services Specialist Training Matrix and any other required means. Training may be delivered in a variety of methods and forums. ACCESS Provider Services Specialist must understand the following areas, in addition to other required trainings:

• BH I/DD Tailored Plan eligibility and services
• Trained on the requirements, policies and procedures of the BH I/DD Tailored Plan operating in North Carolina and are able to respond to all areas within the Provider Manual, including resolving claims payment inquires in one touch.

EDUCATION & EXPERIENCE REQUIREMENTS

• Graduation with a 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

• Graduation with a Bachelor’s degree from an accredited college or university and at least four years of experience with working with adults or children with serious psychiatric, chemical dependence or developmental disability in a community mental health center or similar setting.

The ACCESS Provider Services Specialist must be qualified as a Qualified Professional according to 10A NCAC 27G .0104

Preferred work experience:

• Preference will be given to applicants with 2+ years of experience in a network management-related role handling complex network providers in the health care industry.

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.

SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit .

Vaya Health is an equal opportunity employer.

Work Schedule: Monday – Friday from 9:30 am – 6:00 pm