ACCESS Member Services Specialist

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Conduct phone screenings and gather demographic details.

• Present callers with options among available providers and connect them to suitable services.

• Direct callers to licensed clinicians for urgent or emergency services as necessary.

• Verify and confirm member and recipient eligibility.

• Schedule appointments in accordance with established access-time standards.

• Manage customer-service inquiries related to enrollment, service access, referrals, Social Determinants of Health needs, provider changes, and general information.

• Share information about Vaya Partners, its provider network, community resources, and North Carolina Medicaid services.

• Identify risk indicators and promptly refer to Member and Recipient Services Clinicians.

• Address caller inquiries when feasible or clarify resolution processes and timelines.

• Execute warm transfers and connections to relevant parties.

• Complete call notes, forms, reports, and other electronic documentation during or immediately after calls.

• Observe service-system trends and report gaps and needs to management or Provider Network Development personnel.

• Follow the NCMT Call Grading Rubric and provide person-centered, recovery-oriented customer service.

• Assist with specialized ACCESS Call Center initiatives and perform additional assigned tasks.

⛳️ Requirements

• Bachelor’s degree in a Human Services field and a minimum of two years of experience working with adults or children with serious psychiatric issues, chemical dependence, or developmental disabilities in a community mental health center or a comparable environment, OR a bachelor’s degree from an accredited college or university and at least four years of such experience.

• Must qualify as a Qualified Professional in accordance with 10A NCAC 27G .0104.

• Experience in providing mental health, substance abuse services, or support for intellectual/developmental disabilities.

• Understanding of social work principles, techniques, and practices.

• Familiarity with behavioral health principles and complex treatment and service provision.

• Knowledge of person-centered and recovery philosophies.

• Awareness of mental health, developmental disabilities, and substance abuse disorders.

• Knowledge of governmental and private community organizations and resources.

• Understanding of laws, regulations, and policies governing LME/MCO operations, human services, and utilization management.

• Capability to operate complex telephone and computer systems and multiple technology platforms simultaneously during live calls.

• Proficient in electronically documenting information and completing call notes, forms, reports, and other documentation at the time of the call.

• Ability to communicate clearly and effectively both verbally and in writing.

• Skill in establishing productive working relationships with community members and provider agency staff.

• Ability to engage professionally and effectively with distressed individuals and those who may disagree.

• Capacity to remain professionally responsive in an ethical and sensitive manner.

• Required training in confidentiality and compliance concerning HIPAA, 42 CFR Part 2, and applicable state laws; must sign a confidentiality agreement.

• Must be a resident of North Carolina or within 40 miles of its border.

🏝️ Benefits

• Eligibility for overtime compensation.

• Opportunity for remote, home-based work.

• Work schedule from Monday to Friday.

• 40-hour work week.

• Participation in Customer Satisfaction Surveys at the end of calls (service-quality practice).